Taking an active role toward a lower cholesterol

by Dr. Jacki Hart

Fifty percent of Americans, compared to only 7% of people in Asia, have high cholesterol (total levels above 200 mg/dL). 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 higher HDLs compared with children from America and Australia who are more sedentary and eat a lot of saturated fat and trans fat (these fats are explained below).
The good news is that no matter where you live, several complementary measures can help bring and maintain cholesterol levels to within a healthful range. In this article, I focus on nutrition, herbs, and supplements that are valuable for this purpose.

Fat and cholesterol

While people consume some cholesterol in animal products (e.g., 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.

Foods high in saturated fat include:

• Meats (beef, pork, etc.)
• Butter
• Whole milk
• Ice cream
• Tropical oils, such as palm and coconut oils, found in commercially prepared foods such as cookies and crackers

Foods high in trans fat include:

• Fried foods
• Margarine
• Any 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 provide isoflavones. These plant chemicals actively aid in the reduction of cholesterol; 25 grams of soy protein per day are necessary to affect cholesterol levels.

Some common soy foods and the amount of soy protein they contain are:

• Soy milk - 3 to 10 grams per cup
• Tofu - 5 to 13 grams per 4 ounce serving
• Texturized vegetable protein or TVP - 6 to 11 grams per ½ cup
• Soy flour - 20 grams per ½ cup
• Soy protein powder - 22 grams per 3 tablespoons

Avoid soy flour products that have been prepared through ethanol washing (often noted on the label); this process reduces the isoflavone content. Carbohydrates and fiber

Some people trying to follow low-fat diets actually gain weight and raise triglycerides. This happens when the foods substituted for high-fat foods fat-free cookies and cakes, non-fat frozen yogurt, etc. are high in sugar. These sugars, which are simple carbohydrates devoid of fiber, are converted to triglycerides in the body.

A better way to reduce fat in the diet is to eat whole foods that are naturally low in saturated and trans fats and high in fiber, such as fruits, vegetables, legumes (beans), and complex carbohydrates (whole grains). Oat products are especially helpful in lowering cholesterol, because they are rich in psyllium, a form of soluble fiber that has been shown to help lower cholesterol. Fruits, vegetables, and legumes are also good sources of soluble fiber.

Related to this topic is a modern day myth that high-protein, low-carbohydrate diets are good for you. However, as the American Heart Association explains, "there have been no studies of their long-term efficacy and safety." In other words, there is no proof that such diets high in protein, particularly animal protein (and, therefore, often high in fat as well) will work over a long time nor that they are safe. After several months on a high-protein/high-fat diet, cholesterol generally worsens. There is also a risk of kidney damage, bone loss, electrolyte imbalance, and vitamin and mineral deficiencies.

Omega-3 fatty acids

Essential fatty acids are fats that are necessary for normal cell function, but that cannot be made in our body. Therefore we must obtain them omega-6and omega-3 fatty acids from dietary sources. For optimum health, they should be ingested in a particular overall balance. The typical American diet provides a ratio of omega-6 to omega-3 essential fatty acids between 14:1 and 20:1. To help lower the risk of certain illnesses, such as heart disease, the balance, according to experts in this field, should be 4:1 or less; most Americans need to eat more omega-3s and fewer omega-6s.

Eating omega-3 fatty acids EPA, DHA, and alpha-linolenic acid:

• Lowering of total and LDL cholesterol
• Reduction of triglycerides
• Inhibiting of blood clotting (which lowers the risk of a heart attack)
• Decreased risk of sudden death from heart disease

Foods rich in omega-3 fatty acids include fatty fish salmon, mackerel, herring, etc. and flaxseed. To take in enough omega-3 fatty acids, eat fatty fish at least two to three times per week. (Fish, like soy, is an excellent protein alternative.) Flaxseed can be sprinkled on cereal or in soy shakes. Strive for two to four tablespoons per day, ground within 24 hours of use and kept refrigerated at all times.

Omega-3 fatty acids and fish oils are available as supplements; however, it is safer and healthier to obtain them from dietary sources.

Putting it all together at meal time

Each of the recommendations outlined above can be achieved by following a whole foods diet rich in fruits, vegetables, complex carbohydrates (whole grains), legumes, fish, and soy foods. A registered dietitian can help you translate this advice into a daily eating pattern.

Coenzyme Q10

Also 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.

Cholestin

Chinese studies have suggested that this supplement, also known as red rice yeast, can lower total cholesterol by 11% to 32%; recent studies in the U.S. are verifying those findings. Cholestin, 1200 mg twice a day, works like a statin drug. Cholestin is available as a dietary supplement. Since these supplements are not strictly regulated, check with your doctor on which brand to take, or look for one with a "USP" seal.

Fenugreek

This herb, native to Asia and southeastern Europe, is a legume sold as dried seed, which contains fiber as well as other active ingredients. Fenugreek has been shown to lower total and LDL cholesterol in animals and, more recently, in people with high cholesterol along with either established heart disease or diabetes.

Gugulipid

Also known as guggul gum, Arabian myrrh, and Somalian myrrh, this substance has been well researched in India and is widely used in that country for lowering both cholesterol and triglycerides. The amount suggested is 75 mg/day.

Throughout 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.

"Functional" margarines

These 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%. However, there is some concern that these "functional" margarines may deplete health-promoting antioxidants including vitamin E and carotenoids (such as alpha-carotene, beta-carotene, and lycopene). These concerns reinforce both the importance of a whole foods approach to nutrition, health, and disease prevention, including lowering cholesterol; and the need to avoid "quick fixes" that will not substitute for a well-rounded lifestyle and eating plan.

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.

Garlic

Early studies seemed promising for garlics ability to lower cholesterol, but more recent trials have not confirmed those initial results. As described, soy, fiber, omega-3 fatty acids, cholestin, fenugreek, and gugulipid show much more value for high cholesterol and related problems.

Lowering 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. Youll find that both your body and your mind will benefit.