When we hear about high cholesterol, it’s usually framed as a problem for adults. But did you know kids can have it, too? In this article, I’ll tell you about one of our patients, an active thirteen year-old I’ll call Walter, who recently came in for a TeenCare visit with Dr. Rachel Gilgoff.
Walter presented as a perfectly healthy teen and during his check up Dr. Gilgoff didn’t have any concerns. She ordered routine blood work including a lipid panel which is what’s recommended at his age.
When the test results came back, Dr. Gilgoff and his parents were shocked to see some lipid readings that were in the red zone (yikes!), including a high total cholesterol as well as high triglycerides. Walter’s LDL was also on the elevated side, barely under the “normal” threshold.
Walter is a super sporty kid and ultra-processed foods are not a big part of what he eats—in fact, his mother cooks most of his meals and prioritizes whole foods ingredients, so these levels seemed really inconsistent with Walter’s food choices and activity level. Dr. Gilgoff and I talked about sending him to a lipid specialist because his “lifestyle” didn’t match his test results. We suspected a genetic issue was driving his levels, but when we clarified there wasn’t any family history consistent with high cholesterol, cardiovascular disease or early death due to heart issues, we were left scratching our heads as to why this story wasn’t adding up.
After some consideration, Dr. Gilgoff and I decided to hold off on sending Walter to a specialist. Instead, we advised him and his family to make several dietary changes to see if we could move the needle. Read on to learn how food really is medicine and what foods to eat to reduce cholesterol.
Let’s Back Up a Bit – What is Cholesterol and Why Does It Matter?
Cholesterol is a fat-like, waxy substance that can be found everywhere in the body and without it, we wouldn’t have life as we know it. Per Peter Attia, MD, “The pool of cholesterol in our body is essential for life. No cholesterol = no life.” It supports the production of cell membranes, many hormones, and also vitamin D. The cholesterol found in blood comes mainly from our liver. Cholesterol and other fats are transported through the bloodstream in round particles called lipoproteins. You’ve probably heard of the most common ones, low-density lipoproteins (LDL) and high-density lipoproteins (HDL).
At GetzWell Personalized Medicine, we check lipid profiles (among others) in adolescents in order to get a clearer picture of a teen’s overall health. Ensuring triglycerides and LDL levels are in the healthy range during childhood and adolescence (as well as in adulthood) reduces the risk of developing heart and blood vessel diseases and high blood pressure. These levels also give us a view into how the liver is doing and whether too much sugar and processed foods could be in the mix. Unfortunately, non-alcoholic fatty liver (NAFLD) disease has sky-rocketed in the pediatric population in the last 15 years and has a prevalence of up to 10% among kids. NAFLD is a risk for liver cirrhosis and other serious long-term health problems.
The main cholesterol levels that we check are:
- Total cholesterol: The entire amount of cholesterol that is circulating in the blood.
- LDL: The “bad” cholesterol (there is no good or bad cholesterol) that contributes to plaque buildup in the arteries and can lead to heart attacks and strokes.
- HDL: The “good” cholesterol (again, there is no good or bad cholesterol) that helps clear out the cholesterol that the body doesn’t need.
- Triglycerides: A type of fat that can raise a person’s risk for heart attack and stroke and can reflect, if high, too much sugar and/or ultra processed food are being consumed.
In Walter’s case, his biggest issue was high triglycerides and an LDL that was creeping towards being too high. Elevated triglyceride levels can be caused by certain medical conditions, including diabetes, hypothyroidism, kidney disease, or liver disease. But there are dietary causes as well, which can include a high intake of trans-fat and/or excessive sweets such as soda, candy and other processed foods commonly consumed by us in the western world.
Exercise Plus Food as Medicine to Lower Cholesterol in Children
Our Recommendations: Our pediatricians had three main recommendations for Walter to lower his high cholesterol:
- Eat More Fiber: Research shows that increasing dietary fiber can lower cholesterol. Walter’s goal was to eat 25-38g of fiber per day.
- Increase Omega-3s: Research also shows that increasing omega-3s can lower cholesterol. Omega-3s can come in the form of fish (especially sardines and other small fish) or fish oil supplements. We advised Walter regarding how much fish oil to take in the form of supplements.
- Reduce Simple Carbohydrates: High triglycerides often indicate an excess of calories consumed, likely in the form of sugar or simple carbohydrates. Walter’s “Rx” from us included to further reduce simple carbohydrates.
- Exercise: We didn’t change any exercise routines for Walter since he was already doing plenty with his swim team and other competitive swimming activities he was enthusiastic about.
Walter agreed he’d follow this plan for about 10 weeks, and then we would test his lipids again. If these dietary changes didn’t affect his levels much, we told him and his mother we would refer him to a cardiologist/lipid specialist.
Best Foods to Reduce Cholesterol: Fiber-rich Food Choices
With our clear recommendations in mind, Walter and his family got to work. They soon realized that despite eating vegetables and fruits every day, they had all been way too low on their fiber consumption. Walter and his family are not unusual. Fiber is a super-nutrient of which only 5% of Americans get enough. Eating a fiber-rich diet is associated with better gastrointestinal health and a reduced risk of heart attacks, strokes, high cholesterol, obesity, type 2 diabetes, even some cancers.
To reach the goal of 25-38 grams of fiber a day, it worked best for Walter to aim for 7-10 grams of fiber per meal plus snacks that included seeds, fruit, or vegetables. The key was learning what 7-10 grams of fiber looked like.
Walter’s mom made a list of high-fiber foods and serving sizes and put it on the refrigerator so they could all refer to it easily. Some of the most fiber-rich on the list were: beans (especially navy beans and black beans), chia seeds, pumpkin seeds, raspberries, oats, and avocados.
For breakfast Walter started making oatmeal with frozen raspberries and a greenish banana. Other days, he’d have a whole-grain English muffin with smashed avocado. Weekends would be beans, greens, and scrambled eggs.
Lunch was often a salad or roasted vegetables with brown rice, beans, and a grilled or roasted protein.
For dinner, the family mostly ate vegetables — fresh, grilled, or roasted, beans in some form, sometimes a whole grain like quinoa or brown rice, and fish, chicken, or tofu. Walter also enjoyed a hazelnut-chocolate chia pudding with berries most days.
The biggest change for Walter and his family was how beans became an almost constant side dish—a cup of cooked black beans provides a whopping 15 grams of fiber (and navy beans provide even more).
Adding in the omega 3s was easy for Walter. It was just a couple of extra supplements. Also, he likes canned sardines, so he began eating them once a week or so.
Saying no to treats more often and also opting for complex carbohydrates (like brown rice or a very hearty wheat bread) was hard. But Walter stayed on board with the plan, even if he wasn’t always happy about it.
Retesting Cholesterol
After following this plan for about 10 weeks, Walter got his cholesterol retested and we saw a dramatic improvement: his total cholesterol had dropped 40 points, his triglycerides came in 56 points lower (a whopping 54% lower!) and his LDL dropped 28 points (a drop of over 25%). WOW, just three consistent dietary changes made a HUGE impact on his lipid status.
Moving Forward
All of us, including Walter, were incredibly impressed with his progress over 10 short weeks. All that work (and all those beans!) paid off and showed Walter that his food choices have a big, measurable effect on his health.
As a result, Walter is continuing to make fiber-rich food choices, he thinks twice before grabbing a “junk food” snack, and is continuing to take his supplements.
Curious About Fiber?
If you are interested in learning more about how much fiber you and your family are eating, here is a helpful resource for checking various foods’ fiber content.
If you’re inspired to cook some beans, Rancho Gordo is a terrific resource. Walter’s family usually uses their Instant Pot for black and navy beans: 2 cups of beans, 5-6 cups of water, a couple of bay leaves, salt, and a 2-inch piece of kombu seaweed (to aid digestion). Cook under high pressure for 25 minutes and then let pressure release naturally. And don’t overlook canned beans. They are so convenient and you can dress them up with some sauteed shallots, onions, garlic, and greens.
If chia pudding is more of your thing, Minimalist Baker has some terrific recipes. Walter’s favorite is here. You can substitute whatever milk you like and adjust the amount to change the texture–Walter’s family uses 2 cups of hazelnut milk and 3 tablespoons of maple syrup to make 4 servings.
We Are Here for You!
We are eager to answer any specific questions you may have about dietary fiber, reducing cholesterol, or any other concerns you may have about your kids’ health. Please don’t hesitate to reach out. We look forward to hearing from you!