More than 102 million adults in the United States have blood cholesterol levels that are considered borderline high risk (200 mg/dL and higher), according to the American Heart Association. Of these, about 35.7 million are considered high risk (240 or above). If you are one of them, you’re putting yourself at risk for coronary heart disease, heart attack or stroke.
Many people turn to cholesterol-lowering drugs known as statins (common ones include Crestor, Lipitor and Zocor), which lower bad (LDL) cholesterol levels and raise good (HDL) cholesterol levels, and can slow the formation of plaques in your arteries.
These drugs are considered relatively safe for most people, but they are not recommended for woman who are pregnant or people with liver disease. They can also cause serious muscle problems and may interact adversely with other drugs.
Outside of drugs, there are plenty of natural steps you can take to lower your cholesterol if you are at risk, or even to head off the problem before it occurs. Lifestyle changes such as quitting smoking, increasing physical activity and eating better can play a significant role in lowering your cholesterol. Much research has been done on the role diet plays in lowering cholesterol, and with the wealth of information out there, it may be hard to know where to start.
A recent article, “Lowering LDL-cholesterol through diet: potential role in the statin era,” in Current Opinion in Lipidology summarizes the different dietary approaches proven to be associated with decreasing LDL-cholesterol.
Even if you’re not following it, you probably already know the basics of a healthy diet: lots of fruits and vegetables, whole-grain, high-fiber foods and fish, and a small amount of saturated and trans fats. Since those are pretty much no-brainers, let’s focus on some of the things you might not have heard already.
Increasing fiber intake is associated with lower prevalence of cardiovascular disease. Even with a poor diet that is high in saturated fat, soluble fibers have been shown to lower LDL cholesterol concentration by about 5%-10% in people with high cholesterol and diabetics.
In a recent study, people with mild-to-moderate hypercholesterolemia (high blood pressure) who took 14 grams of Plantago ovata husk (more commonly known as psyllium husk or po-husk) daily for eight weeks saw a mean reduction of 6.1% in LDL cholesterol plasma concentration, as well as a significant lowering (16%) of plasma triglycerides. Besides psyllium husk, other recommended soluble fibers include beta-glucan, pectin and guar gum. These can be found in powder or supplement form at health stores and online.
Sounds delicious, doesn’t it? Well, there are some tastier ways to increase your fiber intake, including:
- Oat bran
- Rice bran
- Citrus fruits
Plant sterols are naturally occurring substances found in plants that have a chemical structure that is very similar to cholesterol. So as they travel through your digestive tract, they help block cholesterol from being absorbed in the small intestine and can prevent real cholesterol from being absorbed into your bloodstream, flushing it out with the waste rather than going into the bloodstream and clogging up your arteries.
You should look to get about 2-2.4 grams per day, and one of the easiest ways is to switch from your regular butter or margarine to one that is fortified with plant sterols. Now that isn’t a green light to start slathering it on everything — these spreads are still high in calories, so use them sparingly.
And there are plenty of other fortified products on your grocery store shelves, including some cooking oils, salad dressings, milk, yogurt, snack bars and juices.
A 1995 study showed that a mean intake of 47 grams per day of isolated or textured soy protein compared with animal protein resulted in a significant reduction in LDL cholesterol (12.9%) and in triglycerides (10.5%) without significant changes in HDL (good) cholesterol. More recent studies have not completely supported this, showing less of a reduction — to the tune of 3% in comparison with milk or other proteins. But these findings still support that soy is helpful in the fight against cholesterol.
Tofu is a great source of soy protein, and there are plenty of creative and tasty ways to prepare it. But if you just wrinkled your nose at that last sentence, you could also try soy butters, milk, cheese, cereals, flour, yogurt or sprouts. Give them a chance; they may not be as bad as you think. And if you just can’t stomach them, soy protein can also be found in supplement form.
Ok, here’s an easy one for most people to (chew and) swallow. Data from numerous studies show that nuts are a powerful ally in lowering cholesterol, although the exact underlying mechanisms remain to be established. In addition to potential heart-healthy nutrients, nuts have a unique fatty acid profile with a high unsaturated to saturated fatty acid ratio. What’s more, they generally fill you up, so adding them to you diet is not likely to cause you to pack on the pounds. So whether prefer walnuts, almonds, peanuts, hazelnuts, pecans or pistachios, grab a handful (about an ounce) a day.
Putting It All Together
The authors of this article make an important point: “When looked at individually, each dietary recommendation has a rather small impact especially if long-term compliance is taken into account. However, when combined together in a comprehensive way, dietary changes may have a significant impact.”
So, in addition to a low-fat diet that is rich in vegetables, fruits and whole grains, people looking to lower their cholesterol naturally should try to consume soy protein, plant sterols, dietary fibers and nuts daily. This may sound like a radical overhaul of your diet and have some saying “Forget it, hand me the pills and pass the french fries.” But before you throw in the towel on the natural route, consider going Mediterranean.
The Mediterranean Diet
Unlike the traditional American, so called “Cosmopolitan Diet” (lots of red meat, blood-clotting fats/oils, blood-pressure raising sugars/salts, few fruits and veggies) the Mediterranean Diet is centered around the following:
Whole grain breads, pastas and cereals: Many of the breads, pastas and cereals we consume have had the outer layers of grains stripped from them when processed, removing much of the nutritional content from the grains. Instead of cutting these items out altogether, just switch to a whole grain version.
Olive oil: Whether for cooking, dipping or dressing, try olive oil instead of butter, margarine or vegetable oil. Olive oil is considered a monounsaturated fat that provides antioxidant protection through Omega-3 fatty acids (i.e., they reduce oxidative stress).
Fresh vegetables and fruits: Aim for eight servings of fresh, unprocessed, raw fruits and/or vegetables a day. It may not be easy, but before you reach for that bag of chips or bowl of ice cream, consider snacking on some carrots or munching on some grapes instead.
Nuts and seeds: We’ve covered this one already, so stock up on some of your favorites and substitute them for less healthy snacks.
Fish and seafood: The Mediterranean Diet contains far more fish and seafood than red meat or poultry. Many fish and other forms of seafood contain high levels of Omega-3 fatty acids (powerful antioxidant) and are considered monounsaturated fats. Salmon, tuna, mackerel and sardines are particularly nutrient-rich fish.
Wine: Wine, particularly red wine, accompanies most evening meals in the Mediterranean Diet. (We’re talking a glass or two, not a bottle.) The grapes from which wine is made contain powerful antioxidant compounds known as polyphenols. One of the most well-known polyphenols associated with red wine is resveratrol. While the Mediterranean Diet contains a fair amount of carbohydrates and fats (albeit healthier ones), polyphenols in the red wine help to offset this.
 Bruckert E, Rosenbaum D, Lowering LDL-cholesterol through diet: potential role in the statin era. Current Opinion in Lipidology 2011; 22:43-48.