A Food-First Approach to Lowering Cholesterol
By Tara Garfield, Rejuvenan Nutrition Team
If you have high cholesterol, chances are you are familiar with statins. Statins are one of the most widely prescribed drugs in the United States (more than 35 million people are taking them at any given time). Statins inhibit an enzyme that our bodies use to make cholesterol endogenously. Our bodies do indeed make cholesterol, and we also get cholesterol from dietary sources, such as animal products.
When cholesterol levels are too high (LDL, or “bad” cholesterol in particular), it increases the risk for heart disease, heart attack, and stroke. Statins can help by working to decrease LDL cholesterol, thereby reducing the risk of major vascular events.
That being said, many dietary changes can help improve cholesterol levels even without prescription medications. Here are our top six, food-first recommendations for heart health:
1. Eat Foods High in Soluble Fiber
Soluble fiber is found in many foods such as beans, legumes, oats, citrus fruits, and potatoes. Soluble fiber works to lower LDL cholesterol by binding to it in the small intestine. The fiber prevents the cholesterol from entering the bloodstream and helps it to exit the body through the feces instead.
Although it is true that soluble fibers can effectively lower elevated serum cholesterol, it is not true that all soluble fibers have this effect. Only highly viscous soluble fibers that are gel forming, like psyllium and beta-glucan, and have a greater resistance to flow have been shown to exhibit this health benefit. Rich sources of viscous fiber include asparagus, Brussel’s sprouts, sweet potatoes, turnips, apricots, mangoes, oranges, legumes, barley and oat bran.
2. Eat Foods Containing Plant Sterols and Stanols
Plant sterols and stanols are substances that occur naturally in small amounts in many grains, vegetables, fruits, legumes, nuts, and seeds. Sterols and stanols are similar in structure to cholesterol and can compete with cholesterol for absorption in the small intestine. As a result, cholesterol absorption is blocked, and blood cholesterol levels are reduced.
Numerous clinical studies have shown that consumption of plant sterols and stanols may lower LDL cholesterol by 7.5 to 12% with intakes of 1.5 to 3 grams per day. Since sterols and stanols have powerful cholesterol-lowering properties, many manufacturers have also started adding them to foods. You can now find sterols or stanols in margarine spreads, orange juice, cereals, milk, yogurts, and even granola bars.
Timing of meals is an important factor for lowering LDL cholesterol when it comes to plant sterols and stanols. A larger LDL lowering effect of 9.4% was found when a yogurt drink with added plant sterols was consumed with lunch, compared to a lowering effect of 6.0% when the yogurt drink was consumed before breakfast on an empty stomach. This is because meal intake triggers gallbladder contractility and stimulates bile flow. No or limited bile flow means there is no or only a minimal release of biliary cholesterol and bile acids into the gut lumen for plant sterols and stanols to compete with for absorption. Therefore, for optimal cholesterol-lowering effects, plant sterols and stanols should be consumed with a main meal at least two times per day.
3. Eat More Soy Protein
Soy is used to make many food products such as tofu, soy milk, veggie burgers, and edamame. On average, eating 25 grams of soy protein per day lowers LDL by 3% to 4% which is a small, but significant amount. Additionally, when soy protein and soy foods are eaten in combination with viscous fiber, nuts, and plant sterols and stanols, LDL cholesterol may be reduced by as much as 29%.
It was once thought that soy foods increased the risk of breast cancer because soy contains plant estrogens called isoflavones, however research has shown this not to be the case. In fact, consuming a moderate amount of soy foods may actually lower the risk of breast cancer. Soy or isoflavone supplements, on the other hand, generally contain higher levels of isoflavones than soy foods, therefore it is not advised to take soy supplements until more research on their safety is available.
4. Consume Omega-3 Fatty Acids
Omega-3 fatty acids are available in a variety of foods such as fatty fish, walnuts, and flax seeds and can also be found in supplements such as fish oil. Studies have found that the DHA and EPA in fish oil can produce favorable changes in several risk factors for cardiovascular diseases, although fresh fish is more effective. As a result, at least two servings of fatty fish per week is recommended.
The American Heart Association encourages the consumption of a variety of fatty fish for heart health; however, it is important to try and limit the consumption of fish high in mercury. King mackerel, shark, swordfish, tilefish and other large prey fish have a higher mercury content and should not be consumed often for this reason, especially by children and pregnant women. Examples of fish that contain omega-3 fatty acids and have a lower mercury content include salmon, albacore tuna, herring, lake trout, and sardines.
5. Drink Green Tea
Some research suggests that the antioxidants in green tea, called catechins, may help lower cholesterol. Green tea’s major bioactive constituent, epigallocatechin gallate (EGCG), is likely the driver behind green tea’s hypocholesterolemic effects. Current meta-analysis of green tea and lipid clinical trials show that green tea extract or green tea beverage significantly decrease both total cholesterol by 5–7 mg/dL and LDL cholesterol by 2–7 mg/dL in various populations. Drinking about 3 cups of green tea per day seems to be optimal in order to reap the most health benefits; however green tea should not be used in place of a physical activity or an overall healthy diet.
6. Exercise More!
Regular exercise, especially aerobic activity, is one of the best ways to increase HDL (or “good”) cholesterol, which picks up excess cholesterol and brings it back to the liver where it can be broken down and discarded by the body. Most likely, the exercise-induced changes in HDL cholesterol are the result of the interaction between exercise intensity, frequency, and duration of each exercise session and length of the exercise training period. It is also thought that exercise-induced changes in HDL are dependent on biological sex, perhaps due to higher HDL levels in women at baseline compared to men. In conclusion, higher levels of HDL are associated with a lower risk of heart disease.
Overall, consuming a healthy dietary pattern that emphasizes a variety of fruits, vegetables, whole grains, low-fat dairy, fish, lean meat and nuts and also limits high amounts of sodium, added sugars, saturated fat, and trans fat will be beneficial for the body in terms of lowering cholesterol and more. Rejuvenan’s at-home cholesterol test through LetsGetChecked helps measure your risk of developing cardiovascular disease and can help you track your progress over time. Use this test to easily update your Rejuvenan LDL cholesterol biomarker and receive a personalized treatment plan based on your results.Early detection and regular monitoring of cholesterol levels can provide for better clinical outcomes and allow you to make proactive lifestyle changes.
Sometimes, however, healthy lifestyle changes aren’t enough to lower cholesterol levels and your doctor may recommend medication. If this is the case, it is still important to continue making the healthy lifestyle changes that will help keep your medication dose as low as possible.
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