Diet taboos for hyperlipidemia

The core dietary taboo for people with high blood lipids is never to completely abstain from daily foods such as meat, eggs, and milk, but to strictly control the excessive intake of added sugars, trans fats, refined carbohydrates, and high-sodium foods. At the same time, they must avoid two extreme misunderstandings: either they dare not touch any nutrients in a vegan diet, or they think that they can eat haiseles after taking lipid-lowering drugs.

Two years ago, when I was doing follow-up work for chronic diseases in the community, I met 62-year-old Uncle Zhang. His physical examination revealed that his triglycerides were 4.7mmol/L. He gave up all eggs and pork when he got home. He only had white porridge with pickles and occasionally ate corn as a snack. However, after a three-month check-up, his triglycerides had risen to 5.2, and he was also found to have mild hypoalbuminemia. He squatted at the door of the clinic for a long time with the report sheet and said, "I haven't touched anything oily, so why is it still high?" ”

In fact, many people's understanding of hyperlipidemia is still based on "eating a lot of oil will lead to high blood lipids." This is considered old history. The 2023 version of the "Dietary Guidelines for Chinese Residents with Dyslipidemia" has already adjusted relevant recommendations. Excessive intake of free sugars (that is, additional added sucrose, fructose, fructose syrup, etc.) has a greater impact on blood lipids than ordinary saturated fat. Believe it or not, people who consume more than 50g of added sugar every day have a 37% higher risk of excessive triglycerides - I once met a 28-year-old Internet girl who does not eat fat or smoke. She orders an iced Americano every afternoon and adds 2 pumps of caramel syrup every time. The physical examination showed that the triglyceride level was 3.6. Later, she gave up syrup and it dropped to 2.1 in less than two months.

Oh, by the way, there is another controversial point here: for a long time, the nutrition community regarded saturated fat as the number one culprit of high blood lipids, and even recommended that everyone completely abstain from foods such as fat and butter. Follow-up studies in recent years have revised this conclusion. As long as the intake of ordinary saturated fat does not exceed 10% of total calories, it has a very limited impact on blood lipids. Instead, it is the added sugar hidden in milk tea, bottled juice, cakes, and preserves that is the invisible driver of many people's inability to lower their blood lipids.

Hidden deeper than added sugar are trans fats that many people mistakenly believe are “healthier.” When many elders buy snacks, they specifically select "vegetable butter" and "non-dairy cream", thinking that they are made from plants and are healthier than animal butter. In fact, it is quite the opposite. These artificially hydrogenated fats will directly increase low-density lipoprotein cholesterol (which is what we often call "bad cholesterol"), and at the same time reduce high-density lipoprotein cholesterol ("good cholesterol"), which is several times more harmful to blood vessels than ordinary lard. Commonly eaten egg tart crusts, shortbread, shortbread, milk tea made with creamer, and cheap chocolate all contain trans fat. I have seen many elderly people reluctant to throw away shortbread that has been at home for half a month. If they eat one piece a day for a month, their bad cholesterol will rise by 1.2mmol/L.

Let’s talk about Uncle Zhang at the beginning. He didn’t touch anything greasy and had elevated blood lipids. The biggest problem was the white porridge and white steamed buns he ate every day. Refined carbohydrates raise blood sugar quickly, and excess carbohydrates will be directly converted into triglycerides in the liver and stored. If your own metabolism is poor, even if you don't eat a bite of meat and eat white rice and steamed buns every day, your blood lipids will still rise.

A common extreme approach should be mentioned here: many people directly cut out all staple foods after being diagnosed with high blood lipids, and eat boiled vegetables every meal, which is actually not necessary. I once met a 40-year-old sister who quit eating a vegetarian diet for half a year. Her triglycerides did not drop much, but she often felt dizzy and lost hair. Later, I asked her to replace the white rice with 1/3 mixed beans and 2/3 white rice. She ate a fistful of rice per meal, and added skinless chicken legs twice a week and steamed saury twice a week. After three months of review, the triglycerides dropped directly from 3.9 to 2.3, and she felt much better. After all, not eating staple food at all will disrupt the body's fat metabolism rhythm, which may easily lead to elevated ketone bodies and metabolic disorders, and the gain outweighs the loss.

There is another point that most people ignore: high-sodium foods can also affect blood lipid control. Excessive sodium intake can damage vascular endothelial function, making it easier for blood lipids to deposit on the blood vessel walls, increasing the risk of arteriosclerosis. Every 100g of pickles Zhang Shu prepares contains nearly 8g of salt. He eats less than half a plate a day, and the salt content of pickles alone exceeds the recommended daily amount of 5g. The endothelium of blood vessels is always damaged, and of course blood lipids cannot be lowered. In addition to pickles, you should also pay attention to the invisible salt in soy sauce, pickles, processed meat products, and takeaways. A regular ham sausage has 1.5g of salt. If you eat two, you will almost have enough salt intake for the day.

Oh, by the way, some people must want to ask: Can egg yolks be eaten? Isn’t it okay to touch even a bite of fat?

This has also been an issue that has been controversial for more than ten years. The old saying is that people with high blood lipids must not eat egg yolks. This has long been changed: ordinary people with high blood lipids are perfectly fine eating less than 7 whole eggs per week. Only patients with familial hypercholesterolemia need to strictly control their dietary cholesterol intake. As for meat, you can eat skinless poultry, lean pork, beef and mutton, especially the Omega-3 in deep-sea fish, which can also help reduce triglycerides. Eating about 100g of salmon and saury twice a week has a better fat-control effect than a vegetarian diet. If you really want to eat a piece of braised pork, it's okay to eat a piece occasionally. As long as you don't eat it every day, there won't be any big problem at all.

In fact, to put it bluntly, there really aren’t that many “no-touch” red lines on a high-fat diet. The key is not to step on those invisible pitfalls, don’t go to extremes, and don’t live like an ascetic. After all, fat control is a lifelong matter. You don’t dare to eat this or touch that every day. If you can’t persist for half a month, you will eat all kinds of food. Instead, it is better to relax and control the amount. It doesn’t matter if you are greedy for a piece of cake occasionally. Long-term stable control is much more effective than short-term extreme taboos.