Cholesterol-reducing medicines, commonly referred to as “statins,” are one of the most commonly prescribed types of drugs in the United States. They are popular because they reduce the risk for heart attacks, stroke, death from heart disease, and even death from all causes. Statins block the action of an enzyme called HMG-CoA reductase, which plays a central role in the production and packaging of cholesterol in our liver. High cholesterol levels add to the build-up of plaque in our blood vessels, leading to stroke, heart attack, and other heart disease, but there are many other factors that contribute as well.
If you have ever wondered if there is more to do to prevent or treat these conditions than just pop a pill, the answer is yes, definitely. There is substantial evidence that lifestyle changes including eating right, exercising regularly, and not smoking cigarettes have significant positive effect on reducing heart disease risk. In the Lyon Heart Study, eating a Mediterranean diet compared to a low fat diet resulted in a 70% reduction of heart events in those who already had some type of heart disease! This is three times more effective than statin drugs in preventing a second cardiac event. A version of the Mediterranean Diet, the Portfolio Diet, showed a reduction of LDL cholesterol by 30%, similar to 20mg of the medicine lovastatin. Wow! Now, if we could just make eating healthy as easy as taking a pill.
You may be familiar with the Mediterranean Diet already, but in review, it guides us to eat the majority of our calories and protein from plant-based foods such as fruits, vegetables, whole grains, beans, and nuts. The fat in our diet should come mostly from olive and canola-based oils and nuts. If a person does eat animal protein, it should mostly come from fish and poultry, limiting red meat.
Let’s break down this healthy diet into more specific parts. Fiber is the structure of food, mostly from plants, that makes us feel full and gives us plenty of “roughage” for good digestion. It also reduces the absorption of cholesterol while reducing the intake of carbohydrates and sugars from our diet. Good sources of fiber you can eat include pectin, concentrated in carrots, apples, and the inner rinds of citrus fruits. One study found that eating two carrots a day decreased cholesterol by 10%!! Oat bran is also a good source of fiber; a study showed eating one bowl of oat cereal daily decreased cholesterol by 5%. Ground flaxseed (best fresh-ground in a coffee grinder, otherwise goes rancid quickly) and barley are also good sources. Many people are familiar with fiber supplements; although food is always the best source, psyllium (such as Metamucil), guar gum, and methyl cellulose (Citrucel) are decent sources of fiber, taken at a dose of 1 Tbsp. in 8-10 oz of water daily.
Overall diets that have more protein than carbohydrates give us lower blood pressure and lower cholesterol. Soy is a healthy, plant-based source of protein especially when compared to milk protein. The daily dose of soy protein for lowering cholesterol is between 20-50 gms. About 10 gms of soy is in 1 to 2 cups of soy milk, 4 oz of tofu, or ½ cup of textured soy protein. If you’ve never tried out soy products, now might be the time to do some experimenting. Eating soy as a food rather than as a supplement has much more benefit to your cholesterol.
Sterols and stanols are types of cholesterol found in plants which prevent unhealthy cholesterol absorption through our gut by about 50%. Eating a diet rich in plants, aiming for 5 fruits and vegetables a day or more, provides a rich source of these plant sterols and stanols. It is one of the most effective and healthy ways of reducing cholesterol. If this is difficult, there are products that contain these stanols, such as the buttery spreads Take Control or Benecol. Beta-sitosterol is a plant sterol nutritional supplement: the most effective dose is 700 mg to 1 gm 30 minutes before each meal.
Nuts are a healthy source of fat, fiber, and plant sterols. Almonds, walnuts, cashews, and Brazil nuts are the healthiest. They are high in calories, so replacing other less healthy fats with nuts is a great way to eat healthier but not add a lot of calories. Regular nut consumption has been shown to reduce the risk of heart disease by 37%! Legumes, which includes beans, lentils, peas, and soy, also contain plenty of fiber and those plant stanols. Only four servings of legumes per week reduce cholesterol and even blood pressure.
We talk a lot about fish oil for cholesterol, too. Fish oil is a type of omega-3 fatty acid, which is a healthier fat than many other animal fats. One study of over 11,000 men with heart disease showed that 850 mg of omega-3 fatty acids reduced their risk of sudden cardiac death by 45%! But taking a fish oil pill is only part of it, as the rest of the type of fat we eat day to day is important, too. Monounsaturated fats found in olive and canola oils, avocados, and nuts are very healthy. Anti-inflammatory omega-3 fatty acids are found in cold water fish (salmon, tuna, sardines, mackerel), nuts, and vegetables, we should eat plenty of these. We should work on decreasing the pro-inflammatory omega-6 fatty acids found in red meat and dairy. The partially hydrogenated vegetable oils found in processed foods—anything that comes in a box or bag that has a long shelf life—are particularly bad for inflammation in our body.
Garlic has been shown to improve cholesterol levels. If you like to cook, add as much garlic in whenever you can. A clove a day is a good goal. After crushing the clove, let it sit at least 10 minutes before chopping and adding to your dish to release the active component, allicin. Artichoke has also been found to be useful, with properties similar to statin drugs. Artichokes can be hard to find regularly in this part of the country, but artichoke extract is more available. The dose is 600 mg three times a day or 900 mg twice a day.
One study found green and black tea also have similar actions on the HMG-CoA reductase enzyme, just like statin drugs. It may be too early to say that drinking tea definitely decreases your cholesterol, but it has so many other health benefits I would encourage you to consider switching over to tea from coffee through the day.
There you have it. Hopefully as many of us feel the need to “detox” following the holiday season’s indulgences, you have some new ideas on specific foods to increase in your diet for your cholesterol, heart, and overall health. Cheers to a healthy and happy 2018!