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Lowering Cholesterol with a Healthier Way of Eating

How is high cholesterol defined?

High cholesterol or hypercholesterolemia is defined as total cholesterol greater than 200 mg/dL with the high risk category greater than 240 mg/dL.

At these levels, particularly when the ratio of LDL to HDL cholesterol is greater than 4:1, risk of cardiovascular disease is significantly increased.

The ratio of LDL: HDL should be at least 4:1 because each HDL can pick up and transport 4 LDL back to the liver.

If I have high cholesterol levels, can a healthy way of eating help me lower them into a normal range?

Absolutely! In fact, a study published in the July 2003 issue of the Journal of the American Medical Association in which a whole foods diet was compared head-to-head with treatment by statin drugs found the whole foods approach to be so effective that the Comment accompanying this JAMA article is entitled, "Diet first, then medication for hypercholesterolemia (high cholesterol)."

(For more discussion of recent studies see below: Research Studies Confirm the Importance of Healthy Foods and Healthy Cholesterol Levels.)

What foods may help me lower my LDL cholesterol and maintain or improve my ratio of LDL to HDL to healthier levels, e.g., 175 mg/dL with a 4:1 ratio of LDL:HDL ?

A diet low in saturated fats and high in soluble fiber from foods such as oats, peas and beans (especially soy beans), has been found to lower elevated levels of LDL and improve the ratio of LDL to HDL.

Cold water fish, garlic and onions, olive oil and other sources of monounsaturated fats have also been shown to lower LDL, while cranberries, soy foods and niacin have been found to raise HDL.

Supplemental niacin has also been found to not only help reduce LDL levels, but to raise levels of protective HDL; however, it is important that you check with your health care practitioner before taking supplemental niacin for this purpose. Niacin is available in a number of different forms, one of which may be significantly more helpful for you than another. In addition, some forms of niacin may cause unpleasant flushing in some individuals. Your health care practitioner can help you maximize the benefits and minimize the potential side effects of supplemental niacin.

If you want to lower your cholesterol levels or even if you’ve never had any problems with high cholesterol and just want to maintain healthy levels, enjoying a Healthier Way of Eating with the World’s Healthiest Foods can help keep your cholesterol levels in check.

Cholesterol is Not Inherently “Bad” for the Body:

In fact, without cholesterol, your body would be unable to make hormones, cell membranes or vitamin D. Normally, cholesterol flows through the blood vessels without causing any damage or the build-up of atherosclerotic plaques. It’s only if cholesterol becomes oxidized by free radicals in the body that it can become problematic. That is why eating foods rich in antioxidants is so important. Foods rich in antioxidants, such as vitamins E, C and beta carotene, can help prevent the oxidation of cholesterol and the damage it may cause to blood vessels.

(For more information on cholesterol, see below: What is cholesterol, and why should I be concerned if my cholesterol levels are too high? What causes high cholesterol?)

EAT MORE:

Foods for Healthy Cholesterol Levels
Nutrient Foods Benefits
Soluble fiber* Oat bran, barley, peas, beans (all types, especially soy) Lowers LDL and improves ratio of LDL to HDL
Niacin* (if LDL levels are already high, supplements may be necessary to reduce levels) Salmon, tuna, chicken, calf liver, halibut, asparagus, crimini mushrooms Helps decrease the body's production and increase its elimination fo cholesterol, prevents oxidation of LDL and can increase levels of HDL cholesterol
Antioxidants:
Vitamin E* Swiss chard, sunflower seeds, spinach, kale, mustard greens Helps prevent prevent the oxidation of LDL cholesterol
Vitamin C* Citrus fruits, broccoli, red bell peppers, kale, Brussels sprouts, kiwi fruit Helps prevent the oxidation of cholesterol
Beta carotene* Carrots, sweet potatoes, winter squash, kale Helps prevent the oxidation of LDL cholesterol
Polyphenols Cranberries Help prevent oxidation of cholesterol and increase levels of HDL cholesterol
Foods rich in taurine and omega 3 fatty acids (e.g., cold water fish), monounsaturated fats (e.g., olive oil, avocado, walnuts) and the allium family of vegetables (e.g., garlic, onions) can also be helpful. These foods' cholesterol-lowering benefits are discussed below under "How Foods Help Lower Cholesterol".
*Click on link for a complete list of foods rich in these nutrients.

AVOID:

Saturated fats and cholesterol Red meat and other animal products Strong association with atherosclerosis and heart disease
Trans-fatty acids (hydrogenated fats) Increase LDL cholesterol and lipoprotein(a) levels

Want suggestions for some delicious cholesterol-lowering meals and recipes?

Just click here for our Atherosclerosis Meal Planner.

How do these foods help lower LDL cholesterol and maintain healthy levels?

Soluble Fiber:

Soluble fiber significantly reduces blood cholesterol levels by several different mechanisms:

  • Decreasing the absorption of dietary cholesterol
  • Increasing the removal of bile
  • Increasing the breakdown of blood cholesterol to produce more bile
  • Decreasing the activity HMG Co-A reductase, a key enzyme involved in the production of cholesterol by the liver

First, soluble fiber in the intestines binds to bile from the liver, so the bile is carried out of the body as waste instead of being reabsorbed. In order for the body to make more bile, which is necessary for digestion, it must break down more cholesterol, removing it from the bloodstream. In addition, because bile is needed for the absorption of cholesterol from food, binding the bile makes it less able to assist in cholesterol absorption, so less dietary cholesterol is absorbed from food as well.

Secondly, when normal levels of bacteria are present in the colon, they are able to break down some of the soluble fiber into what are called short-chain fatty acids. In addition to being the preferred fuel of colon cells and thus essential for good colon and digestive health, some short-chain fatty acids are absorbed into the bloodstream, where they travel to the liver and decrease the action of HMG Co-A reductase, one of the main enzymes involved in the production of cholesterol.

Diets high in soluble fiber have been shown in some studies to lower total cholesterol and LDL cholesterol as much as 20-30%. The soluble fiber used in these studies was the naturally-occurring fiber found in oat bran, beans, and other food sources. In these same studies, the use of cooked soy beans, a rich source of both soy protein and naturally occurring soluble fiber, led to a decrease in total cholesterol of 30% and a decrease in LDL cholesterol of 35-40%.

(For more information, see below: Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Cultures in which soy foods constitute a major portion of the diet typically have much lower rates of heart disease than cultures with a low consumption of soy. In addition to this epidemiological data, clinical studies have shown that soy foods are protective against the development of heart disease and its associated mortality. The beneficial effects found in these studies are due to an intake of whole soy foods and not the isolated soy components that are currently available in supplement form.

Soybeans and foods made from them have been found to significantly decrease the risk of heart disease and heart attack via several mechanisms. Soy can help prevent the oxidation of LDL cholesterol and soy foods have been shown to decrease LDL by 35-40% and total cholesterol levels by 30%, to decrease triglyceride levels, and to decrease platelet aggregation reducing the risk of blood clots. Soy foods may also increase levels of HDL (beneficial) cholesterol.

For more information about soy, click Soybeans.; on fiber, click Dietary Fiber.

Niacin:

Niacin, also known as vitamin B3, has been shown to decrease the activity of HMG Co-A reductase, a primary rate-limiting enzyme involved in the production of cholesterol, thus causing a decrease in the body’s production of cholesterol. Niacin also helps increase the breakdown of cholesterol to bile, decreases the proliferation of smooth muscle cells, helps to prevent LDL oxidation, reduces platelet clumping, lowers lipoprotein(a) levels, and can increase levels of HDL by as much as 15-40%. Increasing HDL levels, particularly through diet, can significantly decrease atherosclerosis progression.

Niacin has been shown to decrease cholesterol levels by 10-26% and to decrease heart attack recurrence by 29%. Niacin given to patients after a heart attack reduced non-fatal heart attack recurrence by 27% and decreased long-term overall mortality by 11%.

For more information, click Niacin.

Vitamin E:

Vitamin E prevents oxidation of LDL cholesterol, prevents the growth of blood vessel plaques, and has been shown to reduce the risk of heart attack and deaths related to heart disease.

The primary fat-soluble antioxidant in the body, Vitamin E is the antioxidant found in highest quantities in LDL cholesterol particles, which it protects from oxidation. As the main antioxidant defender of lipids (fats) in the body, Vitamin E is responsible for putting a halt to chain reactions of lipid peroxidation anywhere in the body.

Vitamin E has also been shown to decrease platelet clumping, prevent the rupture of existing atheromas, decrease the migration of macrophages to atheromas, prevent the inhibition of nitric oxide production, and to decrease the expression of adhesion molecules on the surfaces of endothelial cells (which form the outermost layer of blood vessel walls), thereby reducing the amount of binding that can occur with monocytes and other immune cells.

(For more information, see below: Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Why Whole Foods are Better than Vitamin E Supplements

The potential downside of taking vitamin E as a supplement is that large amounts have been associated with a possible increase in oxidation. This is because, in order to prevent the oxidation of fats, the vitamin E itself must become oxidized. If all of the vitamin E in an LDL particle becomes oxidized, it is then able to cause oxidation of the LDL cholesterol. A way to prevent this from happening is to make sure that enough of the antioxidant vitamin C is available. Vitamin C is very effective at restoring oxidized vitamin E back to its non-oxidized, antioxidant form. For this reason, studies recommend that an increase in vitamin E intake be accompanied by an increase in vitamin C intake.

One more caution for those interested in taking supplemental vitamin E. Because of its ability to decrease platelet clumping and clot formation, supplemental vitamin E should not be used by those taking blood thinners unless they are being closely monitored by their doctor. Getting your vitamin E from foods, however, is highly unlikely to cause such problems. Just remember to include foods rich in vitamin C (discussed next) in your meals as well.

Vitamin C:

The body's primary water-soluble antioxidant, vitamin C is needed for the proper function of blood vessels, regenerates vitamin E, and can help decrease cholesterol levels through several mechanisms. Although vitamin C is not found in LDL cholesterol particles because it is not fat-soluble, it does play a large role in the prevention of LDL oxidation. In addition to restoring antioxidant function to vitamin E, vitamin C also eliminates many free radicals produced by normal body metabolism, thus preventing them from damaging cholesterol.

Low levels of vitamin C have also been associated with higher levels of total cholesterol and LDL cholesterol, and lower levels of HDL cholesterol. Vitamin C is required for the breakdown of cholesterol to bile in the liver and also for the uptake of LDL cholesterol into cells for normal use. Vitamin C use is therefore associated with a decrease in total and LDL cholesterol levels as well as an increase in HDL levels. These effects seem to be most pronounced in men and tend to take about six months of increased vitamin C intake to be significant.

Low vitamin C levels are associated with an increase in cholesterol deposition in the aorta, the main artery leaving the heart. Vitamin C has been shown to decrease the binding of monocytes to atheroma lesions, thereby reducing the rate of atheroma growth. It is especially beneficial in preventing the negative effects of smoking on the blood vessels and heart. Vitamin C also reduces the deactivation of nitric oxide (a chemical messenger that tells blood vessels to dilate) and actually increases its production, leading to decreased vessel spasm and increased vasodilation.

For more information, click Vitamin C and see below, Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

Beta Carotene:

Beta-carotene is another antioxidant found in foods. Although it is not found in high quantities in LDL cholesterol particles, it has been shown to prevent the oxidation of LDL cholesterol. Beta-carotene, like vitamin C, is also able to increase vessel dilation and reduce vessel spasm. One study has shown that patients with the lowest level of beta-carotene intake had almost twice the risk of having a heart attack compared to those with the highest intake. The group of patients taking the highest intake of beta-carotene had about 1/3 the risk of fatal heart attack and about 1/2 the risk of cardiovascular death as those in the group with the lowest intake.

For more information, click beta-carotene and see below LDL Cholesterol Protected by Beta-Carotene.)

Taurine:

Fish are the best sources of taurine. Cold-water fish such as salmon and cod are recommended as these are also rich in beneficial omega-3 essential fatty acids. Taurine is an amino acid component of protein particularly common in fish protein. It has been shown to decrease elevated cholesterol levels by decreasing the absorption of cholesterol in the intestines in addition to increasing the conversion of cholesterol into bile, thereby removing it from the body. Studies have shown that individuals with higher intakes of taurine have a lower risk of death from ischemic heart disease. To gain the maximum protective benefit, eat a serving of fish at least 5 days a week.

For more information about fish, serving ideas and recipes, click cod, halibut, salmon, scallops, shrimp, snapper, yellowfin tuna

Foods Rich in Omega-3 Fatty Acids

Best Food Sources of Omega-3 Fats: cold-water fish such as salmon and cod and their oils, flaxseed and its oil, walnuts, and purslane.

Frequent consumption of fish, especially cold water fish since these contain the most omega-3s, is associated with a decreased risk of heart attack. A high intake of omega-3 fats, when part of a diet low in saturated fat, has also been found to help decrease cholesterol. Foods rich in omega-3s should be used to replace foods high in saturated fats such as meat and dairy products.

Monounsaturated Fats:

Best Food Sources of Monounsaturated Fats include: olive oil, high oleic sunflower oil, avocado, almonds, cashews, peanuts, sesame seeds, pumpkin seeds and walnuts.

Monounsaturated fats are a unique type of fat found in particularly high quantities in olive oil. These stable fats decrease the oxidation of LDL cholesterol, help reduce cholesterol levels, and may partly explain why the “Mediterranean Diet,” which is high in monounsaturated fats as well as whole foods, is protective against heart disease.

Studies have revealed that populations that follow the “Mediterranean” diet, which is high in vegetables and whole grains, and low in saturated fats, but relatively high in total fat due to a high intake of olive oil, tend to have fairly low rates of cardiovascular disease and its associated mortality. Based on studies of fat intake and heart disease in many countries, it would be expected that these populations would have high rates of heart disease because of the level of fat in their diets. However, the opposite is true.

Recent studies have shown that LDL cholesterol particles that contain monounsaturated fats, such as from olive oil, are much more resistant to oxidation that those that contain high levels of polyunsaturated fats, such as from other vegetable oils like corn or safflower oil. In addition, the substitution of monounsaturated fats for saturated fats in the diet has been shown to decrease total cholesterol by 13.4% and to decrease LDL cholesterol by 18%.

The most important aspect of the use of monounsaturated fats is that they be used in place of saturated fats. Adding olive oil to a diet that is already high in saturated and/or trans fats can have negative effects on heart disease progression and risk. Olive oil should instead be used to replace animal sources of fat and other vegetable oils. Even though olive oil is a relatively stable fat, it is important not to use olive oil when cooking foods as high temperatures. Exposing even this more stable oil to high temperatures may cause it to oxidize.

Instead, use our Healthy Sauté or Healthy Stir Fry to cook the food, then after removing it from the heat, add the olive oil. You’ll add all its delicious flavor and health-giving benefits to your food, without potentially adding damaged fats that might cause damage to the fats, including cholesterol, in your own body.

Allium Family Vegetables:

Best Sources of Allium Vegetable Compounds: Fresh, raw garlic and onions contain the highest amounts of these beneficial compounds.

Allium family vegetables contain compounds that have been shown to modestly lower total cholesterol levels, lower blood pressure in cases of hypertension, and slow the rate of plaque growth. One of these compounds, S-propyl cysteine, has been shown to decrease the liver cells’ secretion of apolipoprotein B100 (apo B-100). Apo B 100 is virtually the only protein component of LDL, which is composed of both protein and cholesterol. Apo B-100 is that portion of the LDL molecule that allows it to bind to receptors on other molecules, such as those that make up the lining of the blood vessels. Having a high level of apo B-100 in the blood is therefore a potent risk factor for developing cardiovascular disease.

Other S-Alk(en)yl cysteines found in garlic have been shown to inhibit cholesterol synthesis by lowering the activity of HMG-CoA reductase 30-40%. Garlic incorporated into high fat diets in animal studies has significantly decreased lipid peroxidation (damage to fats such as cholesterol) and the activity of a number of enzymes involved in cholesterol synthesis including HMG CoA reductase.

In a randomized, double-blind, placebo-controlled study involving men with high cholesterol, total cholesterol was lowered 7% and LDL cholesterol 10% among those given aged garlic extract, and in animals receiving garlic, blood levels of total cholesterol and triglycerides dropped by 15 and 30% respectively. In later test tube studies using cultured rat liver cells, garlic, specifically its water-soluble sulfur compounds, was found to inhibit cholesterol synthesis 44-87%. Of all these compounds, S-allylcysteine, was the most potent inhibitor of cholesterol synthesis. In other test tube studies, evidence has been presented that shows several garlic compounds can effectively suppress the oxidation of LDL , and in human subjects, short-term supplementation of garlic has been shown to increase their LDL’s resistance to oxidation.

What foods should I consume sparingly or avoid to promote healthy cholesterol levels?

Saturated Fat and Cholesterol

Excessive dietary intake of foods rich in saturated fat and cholesterol, which are found primarily in meat, particularly red meat, and other animal products, is strongly associated with increased risk of atherosclerosis and heart disease.

Iron

High levels of stored iron are associated with increased free radical production and therefore increased risk of heart attack, especially in individuals with high cholesterol levels.

Hemochromatosis, a condition of iron overload, is common in Caucasian males.

Iron is a transitional metal that can catalyze the formation of free radicals called hydroxyl radicals, which can damage cholesterol and have been linked to cardiovascular disease. Recent studies suggest that the heme-iron from red meat is more likely to produce hydroxyl radicals than the heme-iron in chicken, fish or vegetarian sources of protein (e.g., beans, nuts and seeds, eggs, and low fat dairy products). Using these sources of protein as your dietary staples and limiting red meat consumption is therefore recommended.

Trans-Fatty Acids (Hydrogenated Fats)

Trans fats are so-called since their chemical structure is the mirror opposite of that found in vegetable oils. These abnormally structured fats can be made from vegetable oils by subjecting them to a chemical process that transforms them into solid fats. Also called hydrogenated fats, trans fats increase LDL cholesterol and lipoprotein(a) levels, may be more damaging to the heart and blood vessels than saturated fat, and should be eliminated from the diet. These unnatural fats are virtually absent from whole foods, but are the predominant component in margarine and are frequently added to processed foods, baked goods, coffee creamers, and snack foods.

Vitamin D

Although necessary for bone strength, excessive amounts of vitamin D are associated with plaque build-up, especially in those with low magnesium intake. Increase magnesium intake rather than avoid vitamin D-rich foods such as salmon, tuna, liver, eggs and milk; these foods provide numerous important health benefits. Excellent sources of magnesium include Swiss chard and summer squash. Very good sources include spinach, turnip greens mustard greens, pumpkin seeds, broccoli, , flax seeds, green beans, collard greens, kale, sunflower seeds, sesame seeds, quinoa, buckwheat, salmon, and black beans.

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