Focus on the quality of the food
What can food do in case of illness? There is a whole range of conditions where diet can make all the difference. This episode is about high cholesterol. We spoke to Natascha Smoltsak, a dietician in Amsterdam.
Natascha Smoltsak works in a private practice in Amsterdam and regularly receives referrals from their GP. ‘But it also happens that people make an appointment of their own accord. The dietitian is included in the basic insurance, so you can always make an appointment if you would like nutritional counseling, even without a doctor’s referral.’
High cholesterol from a puff
How is it possible that cholesterol levels get too high? Smoltsak sees various causes: ‘There is a group that gets an elevated cholesterol level as a result of medication. Corticosteroids, for example, can have this as a side effect. If you get a puff for a lung condition, a nasal spray or an injection into an inflamed joint, that can have an effect. I also see that the cholesterol level rises with underlying suffering. Have you had an infection, an operation, a major wound somewhere? That physical stress can cause cholesterol levels to rise. There are also people who have a genetic predisposition to elevated cholesterol levels. But in a large group, lifestyle or the metabolic syndrome is the cause of the elevated cholesterol level.’
Effect of diet
There are medicines to lower cholesterol levels, but what can you do yourself? Yes, because healthy living certainly has an effect on cholesterol levels. Enough exercise, quitting smoking, losing weight to a healthy weight and eating right can lower cholesterol levels. Yet Smoltsak tempers expectations: ‘The effect of healthy eating may be less than you might think. The right diet can lower cholesterol levels by about 10 percent, science shows. Incidentally, I also see better results in my practice, sometimes up to a 25 percent decrease. It depends on the initial situation. If you don’t eat very healthy, you can achieve more effect than if you already eat quite healthy.’
Nutritional advice
Smoltsak focuses in nutritional advice on improving the quality of food. ‘I don’t like banning things. That’s why I like to emphasize what you can eat more, rather than what you should eat less. My advice focuses on eating a lot of vegetables first. At least 250 grams per day, but preferably even more. Vegetables contain soluble fiber that helps lower cholesterol levels. I also emphasize a variety of fats, such as fats from oily fish, avocado, nuts, kernels, seeds and olive oil. Replace your cheese and liverwurst sandwiches for lunch with a salad with fish and olive oil and you’re well on your way. Lean food is not the intention, because it is precisely those natural fats that have a positive effect on cholesterol levels. I also recommend plenty of fruit, and regular legumes and oatmeal, because they also contain soluble fibre.’
metabolic syndrome
‘People with high cholesterol levels regularly have the metabolic syndrome and insulin resistance.’, says Smoltsak. ‘In addition to an elevated cholesterol level, there is also too much belly fat, high blood pressure and/or a disturbed blood sugar level. These are all risk factors for cardiovascular disease. Because of the insulin resistance, I usually recommend a carbohydrate restriction: much less sugar, sweets, biscuits, pasta, rice, potatoes and bread and even more emphasis on vegetables, sufficient proteins and healthy fats. Such nutritional advice often succeeds in losing weight, improving cholesterol levels and lowering blood pressure.’
Alcohol
Is There Another Diet Factor That Affects Cholesterol Levels? ‘Yes!’ says Smoltsak. ‘I really want to emphasize that drinking alcohol has an adverse effect on cholesterol levels. People still fence with the idea that a glass of red wine is good for the heart, but in practice I often see that more is drunk than that one glass. Anyone who lowers the alcohol intake often sees the cholesterol level drop very quickly.’
Statins and red yeast rice
Healthy living does not always have the desired effect, says Smoltsak: ‘Sometimes I get people in my office who eat ‘cleanly’, are healthy, are active and who still have an elevated cholesterol level. I can then at most adjust on small points. Sometimes medicines are the only effective solution.’ Speaking of drugs, most people don’t like them. Statins, which are often prescribed for high cholesterol, can have serious side effects such as muscle and joint pain. Smoltsak recognizes that: ‘These people ask me if they can stop taking the pills. Of course I can’t decide that, they have to go to the doctor for that. But I do know that the red yeast rice supplement is not the solution in any case. This is also a statin and can therefore also cause side effects in some people. In addition, the dosage and origin is often difficult to trace. All in all I stick to good quality food, reducing alcohol consumption and living a healthy life. That is the basis for an elevated cholesterol level.’
