It didn’t worry me that my total cholesterol and LDL (bad) cholesterol numbers were borderline high for a long time. I don’t have other risk factors for heart disease, such as high blood pressure, obesity, and lack of exercise. I haven’t eaten meat for 46 years. My doctors never expressed concern. I chalked test results up to bad genes and disregarded them. 

The last test a couple of weeks ago is harder to ignore. It showed that total cholesterol (245) and LDL cholesterol (150) had climbed into the high zone. 

“Cut out fried and fatty foods,” my doctor emailed me after seeing the results.

I don’t eat fried foods, and the only saturated fat I regularly eat is in reduced-fat mozzarella cheese. I do not want to take medication, however, so I researched whether there are some changes that could be made in my diet.

One of the first articles I read said that diet has little effect on blood cholesterol. “Avoiding foods that are high in cholesterol won’t affect your blood cholesterol levels very much,” a doctor commented. Remember when eggs were restored to the healthy category even though they are high in cholesterol? Researchers had determined that blood cholesterol is produced largely by the body and not by food. 

But that couldn’t mean that we can eat anything, or my doctor wouldn’t have cautioned me to avoid fried and fatty foods. I was confused.

We hear about good cholesterol and bad cholesterol, dietary cholesterol and blood cholesterol — and the concern is really about the lipoproteins that carry cholesterol in the bloodstream. Low-density lipoproteins (LDL) transport cholesterol to the body’s cells, where the cholesterol is separated from the LDL to use for various purposes. High-density lipoproteins (HDL) return excess or unused cholesterol to the liver for excretion. HDLs are the good stuff. LDLs are associated with the buildup of plaque in the arteries; they are known as the bad stuff.

Diet can do something about lipoproteins. My doctor was advising me to avoid foods high in saturated fat. 

Saturated fat — the kind in red meat, full-fat dairy products, packaged baked goods, and tropical oils — increases the amount of LDL in the blood. Trans fat is worse than saturated fat, and the United States has banned it in processed food. Recommendations for an upper limit on saturated fat range from 13 to 22 grams a day. 

Unsaturated fat — the kind in nontropical vegetable oils, nuts, seeds, and avocados — reduces the amount of LDL. Nuts have moved to the good list because their fat is unsaturated.

Foods with soluble fiber are also beneficial in reducing LDL. Soluble fiber binds to LDL particles before they are absorbed into the bloodstream. I suspect that my LDL number may have gone up because I had temporarily stopped eating whole-grain bread and pasta, brown rice, oatmeal, corn, potatoes, and air-popped popcorn to see whether cutting down on carbohydrates would produce weight loss. The foods I eliminated are high in soluble fiber.

Now I’m back to eating oatmeal for breakfast and ditching riced cauliflower (which I didn’t like anyway) for barley, the most heart-friendly grain on many lists. I’ll reintroduce whole-wheat bread and pasta after I lose a few more pounds. Instead of low-fat cheese and nonfat yogurt, my snacks include more fiber-rich foods like nuts, sunflower seeds, edamame, and apples. Beans go into my salads. 

Bottom line: Pay attention to the saturated fat count on food labels, not the cholesterol content. If you want to eat more heart-friendly foods, check out this list from the US Department of Health and Human Services.

In March I’ll see the doctor and have another lipid test. If dietary changes haven’t brought my LDL number down, I will know that I did what I could before consenting to medication.