The Medicare Diet: Best Diet for High Cholesterol in Seniors

Fitness begins with food.

That’s why choosing the best diet for high cholesterol is essential to stave off heart disease. 

In this new series, The Medicare Diet, we’ll discuss tips on adjusting your diet to improve your overall health, and how Medicare Advantage plans can help you meet your goals. 

We aim to encourage sustainable lifestyle changes you can work into your routine, not massive paradigm shifts you abandon after a few months. Even if you don’t have any signs or symptoms of heart disease, working small, sustainable habits into your diet can help improve your overall health and quality of life. Plus, it can be really fun! So without further ado, let’s dive into some key choices you can make to effectively manage a high cholesterol diet plan, as well as some tips on how to lower cholesterol overall.

Lipids: More Than Just Fat

We hear a lot about cholesterol in the media, and most of us know that foods like bacon and hamburgers can be high in cholesterol and that there are good and bad kinds of cholesterol, but what is it really? 

In short, cholesterol is a type of lipid, a common type of compound produced by the body that is used for energy storage, sending signals to other cells, and ensuring our cell membranes stay structurally sound. The most well-known class of lipids are triglycerides, also known as fats. 

While you might assume that cholesterol is also a type of fat, it’s actually a different type of compound called a sterol, a subgroup of steroids. Our bodies use cholesterol to create various hormones like testosterone, estrogen, and cortisol. It’s also used to create vitamin D and bile acid, and plays a major structural role in our cell membranes. In short, we need it, and our cells naturally produce it.

Cholesterol is hydrophobic, meaning it does not dissolve in water. This is unfortunate, as our blood, the body’s primary avenue for resource distribution, is mostly water. As such, our bodies pack cholesterols into special molecules called lipoproteins, which can more easily travel through the blood. When we refer to cholesterol in our blood, we’re usually referring to lipoproteins.

You may have heard talk of “good” and “bad” cholesterol, but that’s something of an oversimplification. Instead, whether a lipoprotein is good or bad depends on its density, and how much of it is present. “Bad” cholesterol typically refers to Low-Density Lipoproteins (LDL), which aren’t inherently bad. They’re simply the body’s most common form of cholesterol transport. 

Problems only begin when our bodies have too much LDL: in these cases, the receptors our cells use to take in LDL shut off. This causes the LDL to drift aimlessly through our body, resulting in a condition called hypercholesterolemia, hyper meaning “high” and -emia meaning “presence in blood”. 

The immune system views these extra lipoproteins as a foreign presence, sending macrophages to consume them. Unfortunately, as more lipoproteins are consumed, the resulting foam cells adhere to the walls of the blood vessels, forming plaque that, eventually, can result in a clog. These clogs stop can blood flow, resulting in heart attacks and strokes. 

“Good” cholesterol refers to High-Density Lipoproteins. These lipoproteins pick up cholesterols from cells and other lipoproteins and transport them to the liver (to be converted into bile) or the steroidogenic organs (to be converted into hormones). They also can help reduce the amount of LDLs in the bloodstream, reducing the risk of cardiovascular disease. 

When we talk about a ‘low cholesterol diet’, we’re not talking about removing cholesterol entirely: that’d be impossible, as our bodies naturally produce it. Instead, we’re talking about balancing cholesterol levels, so our bodies don’t have excessive LDL. High HDL helps keep your LDL levels under control, so having high “good” cholesterol helps, but our main goal is keeping that LDL level down. 

How do I know if I have high cholesterol?

Unfortunately, the only way to identify hypocholesterolemia is through a blood test, as there aren’t any signs or symptoms. Since high cholesterol in seniors is a common problem, you’ll want to get regular blood tests to ensure your levels remain under control. For people over the age of 65, it should be an annual or semi-annual occurrence, as determined by your doctor. 

Unfortunately, even otherwise healthy people can develop hypercholesterolemia. A diet high in saturated fats doesn’t help, but if your body naturally produces more cholesterol than average, you can still encounter problems. Getting tested regularly to identify any issues before they occur is essential.

How to lower cholesterol: What are the best foods to lower cholesterol?

No single type of food is a magic bullet for reducing LDL. However, there are a few kinds of food that can help keep things under control.

Soluble Fiber

This might make you think of Metamucil mixed with their morning orange juice, but fiber does a lot more than keep you regular. Fiber isn’t absorbed by the body, so it’s most commonly associated with the formation of stool. However, water-soluble fiber has another interesting property: it can bind with LDLs, causing them to be passed from the body. 

Soluble fiber is commonly found in whole grains, fruits, vegetables, and legumes and lentils (beans). Eating roughly 5-10 grams of fiber per day can lead to a significant reduction in LDL levels. One easy way to incorporate fiber into your diet is to add a bowl of oatmeal to your breakfast. While the instant stuff works, a trendier approach is to try overnight oats. You don’t even need a stove!

Basic Overnight Oats

(Prep Time: 2+ hours)

Ingredients

• 1 cup rolled oats
• 1 cup almond milk (regular milk also works)
• ½ cup plain Greek yogurt (can be replaced with milk)
• 1 teaspoon honey (or another natural sweetener)
• 1 pinch of salt

Your choice of mix-ins, including…

• Chia or Flax Seeds
• Fruit or Berries
• Granola
• Nuts 
• Vanilla Extract
• Nut Butter

1. Combine oats, milk, yogurt, honey, and salt in an airtight container, such as a mason jar. If using chia or flax seeds, add a teaspoon of them as well.
2. Seal the container, and place it in the refrigerator for at least two hours. Ideally, you should wait overnight. Overnight oats can last for up to five days in the fridge if properly sealed but grow softer with time. 
3. When ready to eat, open the jar. Add a splash of milk if the oats seem too thick: they should have a typical oatmeal consistency. Add any toppings, either directly into the jar, or into a bowl. Enjoy!

Healthy Fats

You’ve probably heard of saturated fats, which are solid fats found in most animal products (like beef and dairy) and in most fried foods. Saturated fats are a bit of a boogeyman in the nutrition field, and are often mentioned in the same breath as trans fats when discussing adverse health effects. 

Trans fats (also called partially hydrogenated oils) are indeed unhealthy, as they’ve been proven to disrupt our body’s ability to process fatty acids. It’s been illegal to add trans fats to food in the United States since 2018, though some foods (like red meat, butter, and shortening) still contain it naturally.  

Saturated fats are a bit more controversial. Some studies indicate that overconsumption of saturated fat can lead to a higher risk of heart disease. Others claim that saturated fats are taking an unfair share of the blame, and that it is other substances in the food (like processed carbohydrates, sodium, and the aforementioned trans fats) that cause adverse health outcomes. Nutrition, as always, is confusing.

So here’s the deal: you don’t need to cut all fatty foods from your diet. Yes, ideally, you should probably lay off the bacon and french fries. However, a sudden change like that is unsustainable. Unless you have a truly epic amount of willpower, you’re likely to fall back onto old habits. Unless you have explicit orders to cut fats from your diet, it’s better to explore ways to replace the unhealthy fats in your diet with heart-friendly alternatives. Here are some examples:

• Red meat contains trans fat, which we know isn’t good for us. Fortunately, much of that trans fat can be found in fattier cuts of meat. Opt for leaner cuts, like sirloin, and remove extra fat from the meat before cooking. If you’re cooking ground beef, use a strainer or colander to drain excess fat, then rinse with hot water and pat with a paper towel to dry. Even with these tricks, you should still limit your red meat intake to no more than 6 ounces a day.
• Lean meats like chicken and turkey are a good source of protein and healthy unsaturated fat, provided you stick to the white cuts. Also, try to avoid anything fried, as that can add extra unhealthy fats
• If you love seafood, opt for salmon, bluefin tuna, or other fish high in omega-3 fats. Avoid Chilean sea bass, which is commonly served in restaurants and serves as a common base for fish sticks. While these fish aren’t necessarily bad for your heart health, they tend to be high in mercury, which is a whole different problem.
• Butter is high in trans fat, so avoiding it whenever possible is a good idea. Instead, consider using healthier replacements. For cooking, vegetable oils are a good alternative source of fat. Olive oil is the gold standard in healthy oils, and is great for cooking. No matter what oil you use, remember to use it in moderation: drenching something in olive oil is no better than soaking it in butter.
• When baking, you can replace butter with avocado or applesauce (but not margarine, as recent research has shown margarine is not particularly healthy either). Applesauce is excellent for applications where melted butter is needed, as it contains soluble fiber (always a plus!) and keeps baked goods moist. Avocado is a good alternative for solid butter due to its beneficial unsaturated fat content, and is best used in chocolate dishes where the mild flavor complements the cocoa. This can have some pretty obvious effects on the food’s color, flavor, and density, so consider only swapping out half the butter for an alternative for a more traditional treat.  

Skip the Sugar

There’s a lot that goes on when we process foods for mass consumption, including adding preservatives, that can have adverse health effects. That’s why so many people go for organic products instead: all-natural ingredients mean they’re better for you, right? 

Unfortunately, not always. One of the biggest markers of food being processed is the addition of salts and sugars, which help give food that addictively craveable property we love so much. Salt and sugar, which can appear under many names in an ingredient list, are natural products. So food producers can add as much of it as they’d like and still claim to be ‘all natural’. In fact, the term organic has nothing to do with how healthy a product is: food is considered organic if it is raised sustainably and without the use of synthetic chemicals. That organic cereal is definitely better for the environment, but it isn’t necessarily better for you.

Too much sugar can wreak havoc on our cholesterol levels, lowering HDL and raising LDL. Not to mention the risk of diabetes that comes with high sugar consumption. You might be tempted to reach for an alternative sweetener instead, but those can also have problems. Let’s take a deeper look:

• Agave: Agave nectar contains low levels of glucose, the sugar most of us are familiar with. This gives it a low glycemic index. However, it gets its sweetness by being loaded with fructose. Unlike glucose, which can be metabolized by every cell, fructose can only be metabolized by the liver, which turns it into fat, which raises your LDL levels.
• Sugar alcohols: A common substitute for sugar in foods, sugar alcohols include things like xylitol, sorbitol, and erythritol. These sweeteners don’t raise blood sugar, and don’t contribute to tooth decay. In fact, xylitol is included in toothpaste and gums because it helps prevent tooth decay. Unfortunately, sugar alcohols are also incredibly potent laxatives when taken in large enough doses. For moderate consumption, this isn’t an issue. However, absent-mindedly munching on sugar-free snacks can lead to severe gastrointestinal distress. Pet owners have another reason to avoid sugar alcohol: xylitol can be extremely toxic to pets.
• Stevia: Stevia, when properly processed into an extract called Reb-A, is generally safe, and can even help lower LDL cholesterol levels. Unfortunately, most stevia products contain either erythritol (a sugar alcohol) or dextrose (sugar), which can have adverse effects if overused. You might be tempted to get around this problem by making your own stevia sweetener, but that’s a very bad idea, as unrefined stevia can dangerously lower your blood pressure and damage your kidneys. 

Instead of trying to maintain your current level of sweets consumption by using a substitute, the best solution for your heart is to practice moderation. An easy way to do that is to try making your own treats. Yes, things like homemade chocolate chip cookies still contain added sugar, but they’ll contain far less than what a commercial bakery will. Skip the pre-packaged mixes and shortcuts and try going from scratch. 

As for alternative sweeteners, Reb-A is probably the best thanks to its LDL-lowering properties, but be aware that it’s 300x sweeter than sugar. Most commercial stevia products use other ingredients to keep the proportions closer to sugar, so follow the instructions on the label if you buy the pure stuff! You should skip the agave, though: while the amount of fructose we get from fruit is usually safe, the amount in agave nectar isn’t worth the reduction in glycemic index.

Ease up on the Salt.

High levels of sodium don’t directly affect your LDL cholesterol levels the way sugar can. Instead, too much sodium can result in high blood pressure, which increases your risk of heart disease. The typical recommendation is to consume no more than 2,300 mg (a teaspoon) worth of salt per day, so choosing low and no-added salt-based products is a good idea.

Those avoiding salts also have a surprising ally in the form of monosodium glutamate: AKA MSG. This much-maligned seasoning has received a bad reputation thanks to the supposed “Chinese restaurant syndrome”, in which people reported headaches and illness after consuming MSG. However, this has no basis in medical fact. When the alleged negative effects of MSG were first reported in the 1960s, they fed into existing biases against the Chinese-American community and their cuisine, which have long been the victims of harmful stereotypes. 

More recent studies have found no negative effects connected to normal MSG consumption. In fact, MSG contains only a third of the sodium found in an equivalent amount of salt, yet has a comparable effect on flavor. 

You can use MSG instead of salt in many savory dishes at a ⅓:1 ratio. That is, if a recipe calls for three teaspoons of salt, you would add one teaspoon of MSG. MSG is available at most supermarkets under the brand name Ac’cent , though you can get it in bulk at most Asian supermarkets. You should not use MSG in place of salt for sweet applications, however. MSG is best known for its ‘umami’ flavor, which is great for meat, but not exactly ideal for things like cakes or brownies.

Putting it all together.

While we’ve listed some of the best foods for lowering high cholesterol here, making a daily bowl of overnight oats and sipping stevia in your tea isn’t going to fix everything magically. A diet is part of a comprehensive health plan. That plan starts with talking to your doctor. In some cases, the moderate approach we take here may not be enough, and more drastic measures will need to be taken. In other cases, your diet may have little to do with your cholesterol levels: our bodies produce LDL naturally, and some produce too much. 

Your Medicare plan will cover regular blood tests and doctor visits, allowing you to identify any troubling trends in your LDL level. However, from there, the options under Original Medicare are limited.

You may want to seek nutritional advice from a professional: in these cases, you’ll want to look for a dietician. These healthcare professionals can provide medical nutrition therapy (MNT), where they monitor your diet through counseling and dietary supplements. 

You may be tempted to seek out a nutritionist instead, but you should be warned: while nutritionists may be highly trained and certified, there is no formal regulation on who can call themselves a nutritionist. As such, while Medicare Advantage plans may cover dietician services, many of them will deny coverage for nutritionists. Ensure your provider is a registered dietician nutritionist (RDN) before committing to service!

If purchasing healthy food is a problem, or if you cannot cook for yourself, you may want to consider a Medicare Advantage plan that includes a grocery benefit or meal delivery. A grocery card can be used to purchase healthy ingredients you may otherwise be unavailable to afford, while services such as Meals on Wheels produce nutritionally balanced meals that are much healthier than typical takeout. If you’re undergoing MNT, your plan may allow you to coordinate these benefits with your dietician. 

Finally, some people require medical assistance to manage their cholesterol. A Medicare Part D plan, or a Medicare Advantage plan that includes Part D coverage, can help pay for these medications. You may be eligible for a Special Needs Plan with your doctor’s approval. In addition to covering your medications, these plans may also cover condition-specific benefits designed to make managing your cholesterol easier. 

Whether you’re looking to manage your condition, or are just looking for preventive care, a Medicare Advantage plan can help. Call one of our licensed agents at (800) 950-0608, or use our free comparison tool to start looking at plans today!