The World's Healthiest Foods

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.

Research Studies Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol Levels

LDL Cholesterol Lowered by a Whole Foods Diet:

In a landmark study, the effects of consuming a diet high in vegetables, fruits, soy foods and nuts were compared to either a control diet that was very low in saturated fat and based on milled whole-wheat cereals and low-fat dairy foods or the same diet plus the statin drug, lovastatin. Study participants, a group of 46 adults (25 men and 21 postmenopausal women with high cholesterol whose average age was 59) were randomly assigned to follow one of these three diets for one month. At the end of the month, all three groups showed a decrease in LDL (bad) cholesterol and C-reactive protein (a marker of inflammation that is a risk factor for cardiovascular disease).

In those on the control diet, LDL dropped an average of 8%, and C-reactive protein dropped an average of 10%.

In those on the whole foods diet, LDL dropped an average of 28.6%, and C-reactive protein dropped an average of 28.2%. In those on the control diet plus lovastatin, LDL dropped an average of 30.9%, and C-reactive protein dropped an average of 33.3%.

No matter your age, education, smoking status or physical activity, the more fruits and vegetables you eat, the lower your blood level of LDL (potentially harmful) cholesterol, suggests research from the National Heart, Lung, and Blood Institute published in the February 2004 issue of the American Journal of Clinical Nutrition. Researchers used data from the Family Heart Study to compare the amount of fruits and vegetables consumed to LDL levels in 4,466 men and women ranging in age from 37 to 66. The higher participants’ intake of fruits and vegetables, the lower their LDL levels. Participants who ate the most produce (4 or more servings a day) had LDL levels about 7% lower than those who ate the least (0 to 1.9 servings daily). (March 26, 2004)

Unique Antioxidant in Oats Protects LDL Cholesterol

Oats, via their high fiber content, are already known to help remove cholesterol from the digestive system that would otherwise end up in the bloodstream. Now, the latest research suggests they may have another cardio-protective mechanism.

Antioxidant compounds unique to oats, called avenanthramides, help prevent free radicals from damaging LDL cholesterol, thus reducing the risk of cardiovascular disease, suggests a study conducted at Tufts University and published in the June 2004 issue of The Journal of Nutrition.

In this study, hamsters were fed saline containing 0.25 grams of phenol-rich oat bran, after which blood samples were taken at intervals from 20 to 120 minutes. After 40 minutes, blood concentrations of avenanthramides had peaked, showing these compounds were bioavailable (able to be absorbed).

Next, the researchers tested the antioxidant ability of avenanthramides to protect LDL cholesterol against oxidation (free radical damage) induced by copper. Not only did the avenanthramides increase the amount of time before LDL became oxidized, but when vitamin C was added, the oat phenols interacted synergistically with the vitamin, extending the time during which LDL was protected from 137 to 216 minutes.

In another study also conducted at Tufts and published in the July 2004 issue of Atherosclerosis, researchers exposed human arterial wall cells to purified avenenthramides from oats for 24 hours, and found that these oat phenols significantly suppressed the production of several types of molecules involved in the attachment of monocytes (immune cells in the bloodstream) to the arterial wall—the first step in the development of atherosclerosis.

Oat avenanthamides suppressed production of ICAM-1 (intracellular adhesion molecule-1) and VCAM-1 (vascular adhesion molecule-1), E-selectin, and the secretion of pro-inflammatory cytokines KL-6, chemokines IL-8 and protein MCP-1 (monocyte chemoattractant protein). Our advice: Cut an orange in quarters or pour yourself a glass of orange juice to enjoy along with your oatmeal. If you prefer some other grain for your breakfast cereal, top it with a heaping spoonful of oat bran.(August 1, 2004)

Walnuts Lower Cholesterol and A Whole Lot More

A study conducted at the Lipid Clinic in Barcelona, Spain, and published in the April 2004 issue of Circulation suggests that walnuts protect the heart by doing much more than just lowering cholesterol.

For four weeks, 21 men and women with high cholesterol followed either a regular, low-calorie Mediterranean diet or one in which walnuts were substituted for about one-third of the calories supplied by olives, olive and other monounsaturated fats in the Mediterranean diet. Then, for a second four weeks, they switched over to the diet they had not yet been on.

Not only did the walnut diet significantly reduce total cholesterol (a drop that ranged from 4.4 to 7.4%) and LDL (bad) cholesterol (a drop ranging from 6.4 to 10%), but walnuts were also found to increase the elasticity of the arteries by 64%, and to reduce levels of vascular cell adhesion molecules, a key player in the development of atherosclerosis (hardening of the arteries).

The researchers found that the drop in cholesterol correlated with increases in blood levels of alpha-linolenic acid, a key essential fatty acid from which omega 3 fats can be derived, and gamma-tocopherol, a form of vitamin E. Walnuts are uniquely rich in both of these nutrients, which have shown heart protective benefits in other studies.

The Food and Drug Administration has recently cleared the health claim that “eating 1.5 ounces per day of walnuts as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease.” "This is the first time a whole food, not its isolated components, has shown this beneficial effect on vascular health," said Emilio Ros, who led the study at the Hospital Clinic of Barcelona. (May 9, 2004)

LDL Cholesterol Lowered by a High Fiber Diet:

A study published in the November 2003 issue of the journal Metabolism also suggests that a diet low in saturated fat but high in fiber, almonds, soy proteins, and plant sterols (called a portfolio diet by the researchers) can produce reductions in cholesterol equal to those reported in recent studies using statin drugs. In this study of 25 individuals with high cholesterol, for 4 weeks, 13 followed a portfolio diet while 12 ate a low-saturated fat diet based on whole-wheat cereals and low-fat dairy foods. The groups then switched diets for a second 4 week period.

While the low-fat diet was far less effective than statins, reducing LDL cholesterol by 12%, the portfolio diet, which reduced LDL cholesterol by 35%, was just as effective as statin drugs. The portfolio diet also improved the ratio of beneficial HDL-cholesterol to LDL cholesterol by 30%. The researchers concluded that combining a number of foods known to help reduce levels of LDL cholesterol may be as effective as taking statin drugs.

Fiber’s ability to decrease cholesterol is one reason that studies consistently report that people whose diets contain the most fiber have a significantly reduced risk of cardiovascular disease. A study published in the September 8, 2003 edition of the Archives of Internal Medicine suggests that eating high fiber foods, such as beans, flaxseed, apples, bananas, barley, oats and prunes, helps prevent heart disease. Almost 10,000 American adults participated in this study and were followed for 19 years, during which time 1,843 cases of coronary heart disease (CHD) and 3,762 cases of cardiovascular disease (CVD) were diagnosed. People eating the most fiber, 21 grams per day, had 12% less CHD and 11% less CVD compared to those eating the least, 5 grams daily. Those eating the most water-soluble dietary fiber fared even better with a 15% reduction in risk of CHD and a 10% risk reduction in CVD.

LDL Cholesterol Lowered and Protected by Monounsaturated Fats:
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%.

Studies in weight-stable persons have shown that a diet including a moderate amount of fat results in lower blood levels of triglycerides and higher levels of beneficial HDL cholesterol than a low-fat diet. Now a new study suggests that a weight-loss diet high in monounsaturated fat and moderate in total fat may be more heart-healthy than one that’s low in fat.

In this new study, published in the February 2004 issue of the American Journal of Clinical Nutrition and funded by the Peanut Institute, 53 overweight and obese men and women were randomly assigned to follow weight-loss diets for that were either very low in fat (18% of calories from fat) or moderate in fat (33% fat, with half the fat from peanut products). Participants consumed the weight-loss diet for six weeks, after which they followed a weight maintenance diet for an additional four weeks.

After the six week weight-loss period, both groups had lost about 15 pounds and lowered their levels of potentially harmful LDL. However, while those on the moderate fat diet kept their protective HDL cholesterol at the same level, thus significantly improving their ratio of HDL:LDL, those on the low-fat diet saw their HDL cholesterol drop by 12%, so their ratio of HDL:LDL did not improve —offsetting some of the heart benefits. In addition, during four weeks of weight maintenance, HDLs remained high in the moderate-fat group, who also further lowered their triglyceride levels, while triglyceride levels rebounded in those on the low-fat diet. (High triglycerides are a problem because they promote fat absorption in the artery wall.) The message: moderate consumption of healthy monounsaturated fats, such as are found in olive oil and nuts, e.g., peanuts, appears to lessen risk of cardiovascular disease more than a low-fat diet. We’d add that the moderate fat diet is easier to follow since a little healthy fat adds satiety and a lot of flavor to your meals.(March 26, 2004)

LDL Cholesterol Lowered by Allium Family Vegetables:

Compounds found in garlic called S-Alk(en)yl cysteines have been shown to inhibit cholesterol synthesis by lowering the activity of HMG-CoA reductase, the key enzyme involved in cholesterol production, by 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.

LDL Cholesterol Protected by Vitamin E:

Studies have shown that people with lower vitamin E levels tend to have a higher rate of ischemic heart disease mortality and vice versa. One study found that people with the highest intake of vitamin E from dietary sources had less than half the risk of cardiac events when compared to those with the lowest intake. Other studies have shown that the use of vitamin E supplements has produced a 50% reduction in the progression of atheroma growth, a 63% decrease in coronary heart disease death, a 34% reduction in risk of cardiac events in women, a 77% decrease in the reoccurrence of non-fatal myocardial infarction, and a 39% decrease in risk of heart disease in men. Overall, the use of vitamin E supplements at any time was associated with a 47% decrease in heart disease related mortality.

LDL Cholesterol Protected by Beta-Carotene:

Although beta-carotene 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.

HDL Cholesterol Increased by Cranberries:

A human study has recently shown that drinking cranberry juice can cause a significant increase in HDL cholesterol levels.

In this three month study, researchers measured cholesterol levels in 19 subjects with high cholesterol after a fasting, baseline blood sampling, followed by monthly samplings. Ten of the subjects were given cranberry juice with artificial sweetener, while the other subjects drank cranberry juice with no added sugars. Like typical supermarket cranberry juices, the drinks all contained approximately 27% pure cranberry juice by volume. Each subject drank one 8-ounce glass of juice a day for the first month, then two glasses a day for the next month, and finally, three glasses a day during the third month of the study. Subjects were not monitored with respect to exercise, diet and alcohol consumption.

Although no changes occurred in their overall cholesterol levels, study subjects’ HDL cholesterol increased by an average of 10% after drinking three glasses of cranberry juice per day. While the mechanism by which cranberry juice changes cholesterol levels has not been clearly established, the researchers have theorized that the effect is due to the fruit's high levels of polyphenols, a type of potent antioxidant.

Compounds in Oranges and Tangerines May Lower Cholesterol Better than Statin Drugs

A class of compounds found in citrus fruit peels called polymethoxylated flavones (PMFs) have the potential to lower cholesterol more effectively than some prescription drugs, and without side effects, according to a study by U.S. and Canadian researchers that was published in the May 2004 issue of the Journal of Agricultural and Food Chemistry.

In this study, when hamsters with diet-induced high cholesterol were given the same diet containing 1% PMFs (mainly tangeretin), their blood levels of total cholesterol, VLDL and LDL (bad cholesterol) were reduced by 19-27 and 32-40% respectively. Comparable reductions were also seen when the hamsters were given diets containing a 3% mixture of two other citrus flavonones, hesperidin and naringin.

Treatment with PMFs did not appear to have any effect on levels of beneficial HDL cholesterol, and no negative side effects were seen in the animals fed the PMF-containing diets.

Although a variety of citrus fruits contain PMFs, the most common PMFs, tangeretin and nobiletin, are found in the peels of tangerines and oranges. Juices of these fruits also contain PMFs, but in much smaller amounts. In fact, you’d have to drink about 20 glasses of juice each day to receive an amount of PMFs comparable in humans to that given to the hamsters. However, grating a tablespoon or so of the peel from a well-scrubbed organic tangerine or orange each day and using it to flavor tea, salads, salad dressings, yogurt, soups, or hot oatmeal, buckwheat or rice may be a practical way of achieving some cholesterol-lowering benefits. The researchers are currently exploring the mechanism of action by which PMFs lower cholesterol. Based on early results in cell and animal studies, they suspect that PMFs work like statin drugs, by inhibiting the synthesis of cholesterol and triglycerides inside the liver. (June 3, 2004)

What is cholesterol, and why should I be concerned if my cholesterol levels are too high?

Cholesterol is a necessary substance that is produced by the body from fatty acids, especially saturated fats, in the diet. Ready-made cholesterol is also absorbed from foods derived from animals. From the bloodstream, cholesterol is taken up by cells and used to make cell membranes, hormones and vitamin D.

Cholesterol is produced in the liver by a number of steps involving several different enzymes. One of the main enzymes involved is called HMG Co-A reductase. This enzyme has the single most control over how much cholesterol is produced. HMG Co-A reductase usually ensures that just enough cholesterol is produced for normal function, but sometimes, especially when the diet is high in saturated fats, it shifts into overdrive and contributes to elevated cholesterol levels. If the diet is also high in cholesterol-containing animal foods, then cholesterol levels may rise even more.

Once produced, cholesterol is carried in the blood by lipoproteins such as very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL), lipoprotein (a), and high-density lipoprotein (HDL). VLDL and LDL distribute cholesterol throughout the body to where it is needed. HDL collects any extra cholesterol not needed by cells and returns it to the liver, thus removing it from the bloodstream where it has the potential to cause damage to blood vessels. For this reason, HDL is often referred to as the “good” cholesterol. The most potentially damaging form of cholesterol is lipoprotein (a). Lipoprotein (a) is a cholesterol-carrying molecule like LDL that also contains a sticky molecule, apolipoprotein, which enables it to adhere more easily to the lining of the blood vessel walls and contribute to atherosclerosis.

Normally, cholesterol in the body that is not used to produce hormones, vitamin D, or cell membranes is eliminated by the liver. The liver converts the cholesterol to bile, which is stored in the gall bladder until it is needed in the intestines. When bile is released into the intestines, it aids digestion by making dietary fats easier to absorb. Much of the bile that passes into the intestines is reabsorbed and recycled for future use. However, if it binds to certain food substances, like fiber, it passes out of the body in the stools, so new bile must be produced from cholesterol to replace the bile that is eliminated. This is one of the reasons why fiber-rich foods such as legumes and whole grains can help lower cholesterol.

When cholesterol in food becomes oxidized, either by heat or free radicals, before it is consumed and absorbed in the intestines, or if cholesterol from food or cholesterol produced by the liver is oxidized by free radicals in the body, it can become dangerous. Oxidized LDL cholesterol is directly toxic to the endothelial cells that line blood vessel walls. It increases the adhesion of immune cells called monocytes and macrophages to vascular lesions (damaged areas in the blood vessel wall), increases the proliferation of smooth muscle cells in the blood vessel wall, increases platelet clumping and clot formation, and inhibits the production of nitric oxide, a messenger chemical that tells blood vessels to relax and dilate.

When macrophages and monocytes are exposed to undamaged cholesterol, they only take in small amounts, but when they are exposed to oxidized (damaged) cholesterol, they take in large amounts, causing them to greatly increase in size. A high blood level of oxidized LDL cholesterol is therefore a strong contributing factor in the initiation and growth of atheromas (cholesterol-filled plaques in the walls of the arteries) and the progression of heart disease.

Atheromas are especially problematic when they develop in the blood vessels of the heart, also known as the coronary arteries, where they may decrease the amount of blood that is available to feed the heart muscle, or where they may eventually lead to a heart attack, (in medical terminology, a myocardial infarction or MI), heart damage, and possibly even death.

By contributing to the formation of atheromas, high cholesterol can lead to atherosclerosis, heart disease, heart attack and stroke. Over half of all cases of coronary heart disease in the United States are attributed to abnormalities in the levels and metabolism of cholesterol and other lipoproteins. On the bright side, even a small decrease in cholesterol correlates with a modest decrease in the risk of heart disease.

What causes high cholesterol?

The primary causes of high cholesterol include diet, obesity, a sedentary lifestyle, heredity, and stress. Obesity and cigarette smoking are correlated with decreases in the protective HDL fraction of cholesterol.

Secondary causes of high cholesterol include hypothyroidism, diabetes mellitus, nephrotic syndrome, and obstructive liver disease.

Drugs known to cause high cholesterol as a side-effect include anabolic steroids, progestins, most diuretics, and some beta blockers.

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