Fifty percent of Americans, compared to only 7% of people in Asia, have high cholesterol (total levels above 200 mg/dL [5.2 mmol/L]). Like high blood pressure, high cholesterol can be silent, not causing any symptoms until it has done significant damage to blood vessels throughout the body, possibly leading to heart disease, a heart attack, or a stroke.
Cholesterol measurements include total, LDL (the "bad" form), and HDL (the "good" form). Triglyceride levels (a fat that travels in the bloodstream) have a significant effect on heart disease risk as well. To improve heart health, total, LDL, and triglycerides should be lowered, while HDL should be increased. Lowering triglycerides helps maintain a favorable HDL level.
The accumulation of cholesterol in our blood vessels, unfortunately, begins quite young and, despite some individual genetic variations, depends primarily on diet and activity level. Japanese children, for example, who exercise regularly and eat a lot of soy protein, have lower total cholesterol compared with children from America and Australia who are more sedentary and eat a lot of saturated fat and trans fat.
The good news is that no matter where you live, several complementary measures can help bring and maintain cholesterol levels to within a healthy range. Healthy cholesterol habits include:
Ascertain your healthiest weight, and maintain yourself at that weightExercise regularlyGet regular (at least annual) screenings so that you know your cholesterol levelEat a diet low in cholesterol and saturated fatFollow your doctors recommendations regarding taking anti-cholesterol medications Dietary MeasuresFat and Cholesterol While people consume some cholesterol in animal products (eg, meat, dairy, shellfish, eggs), the dietary components most responsible for driving up cholesterol levels are fats, specifically saturated and trans fats. Limiting saturated fat intake to less than 10% of total calories (less than 7% in someone who already has a high LDL), and trans fat intake to less than 2% of total calories will help lower cholesterol. There's an interesting paradox, however. Reducing saturated fats, while it lowers LDL and total cholesterol, also lowers HDL and raises triglycerides. Monounsaturated fats (such as those found in olive oil and canola oil) appear to improve all aspects of the cholesterol profile. On this basis, some have suggested that it is more important to increase monounsaturated fats than to decrease saturated fats. It has also been pointed out that if a diet causes weight loss, cholesterol profile will improve regardless of dietary composition.
Foods high in saturated fat:Meats (beef, pork, etc.)ButterWhole milkIce creamTropical oils, such as palm and coconut oils, found in commercially prepared foods such as cookies and crackers Foods high in trans fat: Fried foodsMargarineAny food containing hydrogenated oils; these oils are used in many commercially prepared foods such as cookies, crackers, and baked goods. Check the Nutrition Facts label for the saturated fat content of a food. Trans fats are not listed separately, but appear in the ingredients list as "hydrogenated" and "partially hydrogenated" oils. Soy Protein Compared to animal-based protein sources that tend to be high in saturated fat, soy provides a leaner source of protein. In addition to replacing cholesterol-raising saturated fat, soy foods appear to directly reduce cholesterol levels; 25 grams of soy protein per day are necessary to affect cholesterol levels. It was once thought that the isoflavones in soy are the cholesterol-lowering ingredients, but the case is no longer so clear cut, and at present the exact contribution of soy isoflavones is unknown. Some common soy foods and the amount of soy protein they contain:Soy milk3 to 10 grams per cupTofu5 to 13 grams per 4 ounce servingTexturized vegetable protein or TVP6 to 11 grams per cupSoy flour20 grams per cupSoy protein powder--22 grams per 3 tablespoonsAvoid soy flour products that have been prepared through ethanol washing (often noted on the label); this process reduces the isoflavone content.
Fiber Foods high in fiber may reduce cholesterol levels. Oat products are especially helpful in lowering cholesterol because they contain beta-glucan, a soluble fiber that helps remove cholesterol from the body. Fruits, vegetables, and legumes are also good sources of soluble fiber. Other Supplements and HerbsOmega-3 Fatty AcidsThe "good fats" found in cold water fish appear to lower triglycerides, and may provide other heart healthy benefits. A typical dose is 3-9 grams daily."Functional" MargarinesThese margarines Benecol and Take Control are made with sterol esters, which are isolated from soybeans, and are believed to decrease total and LDL cholesterol anywhere from 9% to 20%. Related substances known as sterols and sterol esters are also effective.Artichoke LeafAn extract of artichoke leaf showed cholesterol-lowering properties in one meaningful double-blind study.Red Yeast Rice Red yeast rice is a traditional Chinese medicinal substance that is made by fermenting a type of yeast called Monascus purpureus over rice. It contains cholesterol-lowering chemicals in the statin family, including one identical to the drug lovastatin. Like statin drugs, red yeast rice appears to be effective for reducing cholesterol. Presumably it also presents the same safety risks as statins, compounded by the uncertainty regarding how much active drug any particular batch of red yeast rice contains.
NutsA growing body of evidence suggests that increased consumption of nuts such as almonds, walnuts, pecans, and macadamia nuts may improve lipid profile and reduce heart disease risk.Friendly BacteriaSome but not all studies suggest that "friendly" bacteria might be able to reduce cholesterol levels.Coenzyme Q10Also called ubiquinone,Coenzyme Q10 (CoQ10) is an antioxidant that may be taken concurrently with cholesterol-lowering medications known as "statins" (atorvastatin, cerivastatin, fluvastatin, lovastatin, pravastatin, simvastatin). These drugs tend to deplete normal stores of CoQ10; the recommended dose is 100-200 mg/day. A Few Myths to DispelThroughout this article, I have tried to give a sense of positive things to do to lower cholesterol levels and avoid associated problems. I would also like to address a few popular approaches that should be avoided or, at the very least, not encouraged.GugulipidAlso known as guggul gum, Arabian myrrh, and Somalian myrrhthis, sticky gum resin has been widely marketed as a cholesterol-reducing herb. However, while preliminary studies found evidence of benefit, they all suffered from significant design flaws; a well-designed study did not find guggul effective.TocotrienolsSubstances related to vitamin E called tocotrienols are sometimes promoted as improving cholesterol levels, but the evidence regarding whether they really work remains inconsistent at best.
Fat Substitutes Although fat substitutes, such as Olestra , may reduce the amount of fat and/or calories ingested, their long-term safety is not clear. Also, these substances are known to decrease the absorption of fat-soluble vitamins A, D, E, and K. GarlicEarly studies seemed promising for garlic's ability to lower cholesterol, but more recent trials have not confirmed those initial results. A Total Heart-healthy LifestyleLowering high cholesterol is essential for preserving heart health. In addition to the measures addressed above, strive for a lifestyle that incorporates regular exercise as well as stress-reducing techniques, such as yoga and meditation. You'll find that both your body and your mind will benefit. RESOURCES: American Academy of Family Physicianshttp://www.aafp.org American Heart Associationhttp://www.americanheart.org/ CANADIAN RESOURCES: Canadian Family Physicianhttp://www.cfpc.ca/cfp/ Heart and Stroke Foundation of Canadahttp://ww2.heartandstroke.ca REFERENCES American Heart Association website. http://www.americanheart.org/. Cooper DA, et al. Dietary carotenoids and certain cancers, heart disease, and the age-related macular degeneration: a review of recent research. Nutr Rev. 1999 Jul;57:201-14.
Heber D, Yip I, Ashley JM, et al. Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement. Am J Clin Nutr. 1999;69:231-236. Krauss RM, et al. AHA dietary guidelines. revision 2000: a statement for healthcare professionals from the nutrition committee of the American Heart Association. Circulation. 2000 Oct 31;102:2284-99. Morelli V, et al. Congestive heart failure and hypercholesterolemia: alternative therapies: part II. Am Fam Physician. 2000 Sep 15;62:1325-30. Simolpoulos AP, Robinson J. The Omega Plan. Harper Collins Publishers, Inc.; 1998. Last reviewed January 2008 by Rosalyn Carson-DeWitt, MDPlease be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.