Foods That Lower Cholesterol

For many people, a little alcohol, such as the ritual evening cocktail, is a sure cure for the day's troubles. These same individuals might not be surprised to learn that when consumed in moderation, alcohol may also offer some protection against heart disease. Research has shown that moderate consumption of alcohol can raise HDL cholesterol.

It may also decrease blood clotting and insulin resistance and is linked to lower levels of certain markers of inflammation, such as C-reactive protein, all of which may reduce the risk of heart disease. A modest alcohol intake may also reduce the risk of diabetes. This should be good news for those who imbibe in moderation -- that is, up to one drink per day for women and up to two drinks per day for men. (One drink consists of 1.5 ounces of hard liquor, 5 ounces of wine, or 12 ounces of beer.)

In the early 1990s, epidemiologists -- experts who specialize in the study of large populations to determine how various diseases occur and spread and how they can be controlled -- looked at data from countries around the globe and noticed that the coronary death rate for people in France was considerably lower than for people in the United States, despite French people's well-known love of high-fat foods.

In fact, the phenomenon called the French Paradox relates to the fact that the French have fewer heart attacks than Americans. This is a situation that could not be explained simply by comparing cholesterol levels in the two countries. Experts felt that this difference was due primarily to the French diet, which contains more red wine, fruits, and vegetables. Although red wine contains antioxidants and other compounds that may help prevent blood clots or the oxidation of LDL cholesterol, it has not been shown that only red wine is protective. In fact, most studies have linked moderate consumption of alcohol in general -- including wine, beer, and hard liquor -- to a reduced risk of heart disease.

But experts raise a red flag at the idea of encouraging the consumption of alcohol in order to raise HDL cholesterol or lower coronary rates. Not only are there better ways to raise HDL cholesterol (for example, regular physical exercise), but also not everyone can handle alcohol well.

Many doctors are concerned about safe levels of alcohol consumption for patients. They point out that consumption of as few as three to five alcoholic drinks per day is associated with adverse health effects, and heavy alcohol consumption may raise blood pressure, increase blood triglycerides, damage the liver, cause birth defects (when alcohol is consumed during pregnancy), and increase the risk of developing certain forms of cancer. Also, the majority of those who develop drinking problems drink relatively small amounts.

A much safer bet for lowering cholesterol is increasing the fiber in your diet. See the next page to learn the types and sources of dietary fiber.

Dietary fiber is found exclusively in plant foods. It serves as the structural framework in plants and is one of the most abundant compounds in nature. Fiber is the part of the plant that is not broken down in the intestines by human digestive enzymes. Because it is not digested, fiber is not absorbed in the body. (Bacteria in the intestines can ferment soluble fiber, changing it to short-chain fatty acids that are absorbed, but in general, fiber itself is neither digested nor absorbed.)

Fruits, vegetables, whole-grain breads and cereals, nuts, and legumes (such as dried beans, lentils, and peas) are all sources of fiber in the diet. Fiber is beneficial for a number of reasons. It helps improve intestinal health, prevents heart disease and some cancers, reduces blood pressure, regulates blood sugar, and aids in weight control.

Fiber can be either insoluble or soluble, although most fiber-containing foods have both. Insoluble fiber speeds up the movement of food through the intestines and promotes regularity. It is excreted largely intact. Insoluble fiber can be found in whole-grain foods, wheat bran, many vegetables, and fruit with skin. Soluble fiber -- also called viscous fiber -- dissolves when mixed with water and becomes a gel-like substance, slowing down the movement of food through the small intestine. Sources of soluble fiber include oats, peas, beans, apples, and citrus fruits; one serving of any of these foods provides about one to three grams (g) of soluble fiber.

Evidence suggests that soluble fiber is more effective at lowering cholesterol, but both types of fiber are important for your health. One of the ways soluble fiber may lower blood cholesterol is through its ability to reduce the amount of bile reabsorbed in the intestines. It works like this: When fiber interferes with absorption of bile in the intestines, the bile is excreted in the feces. To make up for this loss of bile, the liver makes more bile salts. The body uses cholesterol to make bile salts. So in order to obtain the cholesterol necessary to make more bile salts, the liver increases its production of LDL receptors.

These receptors are responsible for pulling cholesterol out of LDL molecules in the bloodstream. Therefore, the more bile salts are made from the liver, the more LDL cholesterol is pulled from the blood. There is more to be learned about the relationship between soluble fiber and cholesterol, however. It is also possible that one of the short-chain fatty acids produced by the fermentation of soluble fiber in the large intestines may inhibit the amount of cholesterol produced by the liver.

Research has shown that increasing soluble fiber by 5 to 10 g a day reduces LDL cholesterol by about five percent. Oat bran and oatmeal, as well as psyllium and barley, are rich in beta-glucan, a soluble form of fiber, which has been shown to lower total cholesterol and LDL cholesterol.

Evidence suggests that more than 11 g of beta-glucan from oats can lower cholesterol up to 14.5 percent. (In one study, 3 g of beta-glucan was equivalent to about 2.5 ounces of oat bran.) In fact, according to the Food and Drug Administration (FDA), foods such as whole oats and barley that contain at least 0.75 g of beta-glucan soluble fiber per serving can state on their label that they may reduce the risk of heart disease, along with a diet low in saturated fat and cholesterol.

The National Cholesterol Education Program (NCEP) suggests that people adhering to the therapeutic lifestyle changes (TLC) program -- a diet and exercise program designed to lower cholesterol -- get at least 5 to 10 g of soluble fiber a day, but 10 to 25 g of soluble fiber is recommended to lower LDL cholesterol even more.

The National Academy of Sciences recommends that men and women get even more fiber: up to age 50, men should get 38 g and women 25 g of total fiber -- meaning insoluble and soluble fiber -- each day, and men age 50 and older should get 30 g and women 21 g each day. However, Americans are only getting about 15 g of fiber each day. Diets rich in fat, such as the typical American diet, are generally low in fiber because the most common sources of dietary fat -- foods of animal origin or commercially prepared baked goods -- contribute little or no fiber to the diet.

The best way to increase fiber in the diet is to eat more fruits, vegetables, whole grains, and legumes. Incorporating high-fiber foods into recipes -- for example, adding beans to soup or oats to muffins -- also helps to increase the amount of fiber in the diet.

Fiber supplements can be purchased, but because they are concentrated forms of fiber, it's best to start slow. Switching from a low-fiber to a high-fiber diet should be done gradually to avoid diarrhea, gas, and other types of stomach and intestinal discomfort. Although it's possible that very high intakes of fiber -- at levels associated with the use of supplements -- may reduce the body's ability to absorb certain minerals, it generally should not be a concern if the daily diet includes a variety of nutritious foods.

Another food that has natural cholesterol-lowering properties is fish. Read on to learn why fish and fish oils can be a healthy addition to any diet.

A group of Eskimos in Greenland provided the first indication that fish and fish oils could play a beneficial role in controlling cholesterol and preventing coronary heart disease. It seems that although these Eskimos consumed a diet rich in fat, they had low blood-cholesterol levels and rarely suffered from heart disease. Closer scrutiny of the Eskimo diet uncovered fish as the source of most of the fat.

The fat in these fish, however, was different from the fat found in other animals. It was rich in two polyunsaturated fatty acids, docosahexanoic acid (DHA) and eicosapentaenoic acid (EPA). These omega-3 fatty acids, as they are called, are found in marine vegetation called phytoplankton. Fish obtain these fatty acids by feeding on phytoplankton and then storing them in their own body fat.

Depending upon where they feed and how much fat they store, fish have different amounts of these fatty acids; therefore some fish are better than others as sources of omega-3 fatty acids. Salmon, mackerel, sardines, herring, anchovies, albacore tuna, and lake trout are some of the richest sources. Some eggs, margarine, pasta, milk, and meat are now enriched with omega-3 fatty acids as well.

The omega-3 fatty acids, DHA and EPA, in fish are thought to prevent irregular heartbeat (arrhythmia), reduce inflammation and the risk of blood clots, decrease high triglyceride levels and blood pressure, and modestly improve HDL cholesterol. Fish may also help lower LDL cholesterol when substituted for foods that are high in saturated fat, such as meat. However, some of the benefits of fish can be lost when cooked improperly. Steer clear of fried and breaded fish and frozen fish sticks, which can be high in saturated fat and trans fat. Also, cooking fish in butter or lard decreases the nutritional value by adding saturated fat and cholesterol. The best way to cook fish is broiling or baking it.

While it's true that there are trace amounts of mercury in nearly all fish, it is usually not a health concern for most people. The Food and Drug Administration and the Environmental Protection Agency, however, advise that young children, nursing mothers, and women who may become or who are pregnant should not eat shark, swordfish, king mackerel, or tilefish because they are higher in mercury than other fish. They should also eat no more than six ounces of canned albacore, or solid white, tuna each week; canned albacore tuna has a higher mercury content that canned light tuna. In addition, it is recommended that these groups of people limit their consumption of locally caught fish to six ounces per week unless local government safety guidelines direct otherwise.

Polychlorinated biphenyls (PCBs) are environmental toxins found in salmon. Because PCBs accumulate in fat, removing the skin and cooking the fish so that the fat can drip off reduces the amount of PCBs in the salmon. Wild and canned salmon are lower in PCBs than farmed Atlantic salmon. (Most Atlantic salmon sold in the United States is farmed.) However, the best way to minimize your exposure to toxins is to vary your selection of fish.

The American Heart Association recommends that people who have or are at high risk of cardiovascular disease, and even those who are healthy, should eat a variety of fish at least twice a week. But what if you don't like eating fish? Talk with your doctor about taking a fish-oil supplement. People with heart disease should consume 1 g of DHA and EPA daily from fish, supplements, or a combination. And those with high blood triglycerides should take 2 to 4 g of DHA and EPA daily from supplements; any amount over 3 g should be taken under a doctor's care, as high amounts of omega-3 fatty acids can cause internal bleeding in some people.

Many supplements claim to contain one gram of fish oil, but it can vary. Total how much EPA and DHA are present in the supplement to determine how much omega-3 fatty acid the supplement actually contains. High potency pills contain 800 to 900 mg of EPA and DHA. The most concentrated pills are available by prescription only. To avoid a fishy aftertaste, keep the fish oil supplements in the refrigerator. Omega-3 fatty acids should not be used to lower LDL cholesterol; in fact, they may slightly raise LDL cholesterol.

Unlike fish oil, which can have an unpleasant aftertaste, garlic is a delicious way to not only spice up foods, but also to help lower cholesterol. See the next page for more information about the benefits of garlic.

The use of garlic as an aid for improving health is older than its use as a food. In ancient times, the garlic bulb was considered a common treatment for deafness, dropsy (abnormal accumulation of fluid in the body), intestinal parasites, leprosy, respiratory illnesses, and loss of appetite. Today, garlic is more commonly used as a food or food seasoning.

It is available in its natural bulb form and as a tablet, capsule, dried powder, and aged extract. However, raw garlic, which has a high concentration of a sulfur-containing compound called allicin, is more medicinally powerful than cooked garlic. Research on garlic's cholesterol-lowering effects has been inconsistent, mostly due to poorly designed studies and differences in the garlic preparations used. In the early 1990s, evidence suggested that garlic reduced cholesterol 9 to 12 percent, but in 2000, a review of the evidence found that garlic reduced cholesterol by only 4 to 6 percent. A study that used dried garlic powder over 8 to 12 weeks showed significant reductions in total cholesterol, LDL cholesterol, and triglycerides, but the effect didn't last beyond six months of treatment, suggesting that garlic has only a short-term effect on cholesterol. If you choose to include more garlic in your diet, the worst outcome may be strong breath or an upset stomach. But remember that garlic, in whatever form, is just one way to help lower your cholesterol. Your top priority should be a balanced, healthy diet that includes vegetables, fruits, whole grains, beans, low-fat dairy, lean protein, and unsaturated fats.

One surprisingly healthy source of unsaturated fat is nuts. Read on to explore the benefits of including nuts -- in moderation -- to a healthy diet.

Nuts have gotten a bad rap as a high-fat, high-calorie snack, but adding nuts to your diet may actually be good for your heart. Studies have consistently linked nuts to a lower risk of heart disease. The Nurses' Health Study found that those who ate nuts at least five times a week (five or more ounces weekly) had a 35 percent lower risk of heart disease than women who rarely ate nuts. Another study found that men who ate nuts at least twice a week reduced their risk of sudden cardiac death by 47 percent and their risk of death from heart disease by 30 percent.

Research suggests that a moderate-fat diet (35 percent total calories from fat) that includes up to 3.5 ounces of nuts, especially almonds, walnuts, pecans, or peanuts, lowers total cholesterol 2 to 16 percent and LDL cholesterol 2 to 19 percent. The cholesterol-lowing effect is largely attributed to the unsaturated fat found in nuts; however, other components -- such as fiber, vitamin E, the amino acid arginine, and phytonutrients, including plant sterols -- may also have beneficial effects on blood cholesterol.

According to the Food and Drug Administration, eating 1.5 ounces of certain nuts -- including walnuts (which contain omega-3 fatty acids), almonds (which contain calcium), hazelnuts, pecans, pistachios, some pine nuts, and peanuts -- as part of a diet low in saturated fat and cholesterol may reduce the risk of heart disease. Brazil nuts, macadamia nuts, and cashews have more saturated fat than other nuts; however, they too have beneficial components. Brazil nuts, for example, are very high in selenium, a powerful antioxidant.

It's important to remember that all nuts are high in fat, even if it's heart-healthy fat, so the calories can add up fast. If you want to add nuts to your diet but don't want to gain weight, eat nuts instead of -- not in addition to -- a snack that's high in sugar, saturated fat, or trans fat.

A good way to lower saturated fat intake is to substitute olive oil in many recipes. See the next page to find out why olive oil is a more heart-healthy alternative to traditional cooking oils.

Olive oil has long been popular for both cooking and seasoning in Mediterranean countries. These days, however, it's being rediscovered in America. The low frequency of heart disease among those living in Mediterranean countries, despite lifestyles similar to more industrialized nations, has made us look more closely at their diets. The Mediterranean diet is lower in saturated fat than the typical American diet, but the total fat content can range from under 30 percent of calories to more than 40 percent of calories, which is considered high by American dietary guidelines. A distinctive difference between the two diets is the amount of monounsaturated fat in the Mediterranean diet.

The heavy use of olive oil by people living in that part of the world is the source of the high level of monounsaturated fat in their diets. Olive oil is rich in oleic acid, the most common monounsaturated fatty acid found in the diet. Numerous studies indicate that monounsaturated fat is about as effective as polyunsaturated fat in lowering total blood cholesterol and LDL cholesterol, when substituted for saturated fat in the diet. Plus, monounsaturated fat does not lower beneficial HDL cholesterol or raise triglycerides, unlike polyunsaturated fat, which, at high intakes, may lower HDL cholesterol.

The Food and Drug Administration allows manufacturers of olive oil to claim that "limited but not conclusive evidence suggests that eating about two tablespoons of olive oil daily may reduce the risk of coronary heart disease due to the monounsaturated fat in olive oil." Despite this qualified health claim, keep in mind that regardless of the type of oil you use, all oils have the same amount of calories -- 120 per tablespoon. To avoid weight gain, watch your portion size, and use oil in place of -- not in addition to -- other fats in your diet.

Olive oil, vegetable oils, fruits, and vegetables all contain plant sterols and stanols. To find out how these compounds can help lower blood cholesterol, see the next page.

Plant sterols and stanols -- also called phytosterols -- are compounds present in small quantities in many plant foods, including fruits, vegetables, and vegetable oils. Plant sterols and stanols can be found in a variety of enriched products, including certain margarines, orange juice and orange drinks, salad dressings, and snack bars, as well as in supplements.

When added as an ingredient in food at higher levels than found naturally, phytosterols can lower LDL cholesterol. Studies have shown that consuming 2 to 3 g a day of plant sterol or stanol esters can lower LDL cholesterol by 6 to 15 percent -- often within weeks -- without affecting HDL-cholesterol or triglyceride levels. This is possible because these compounds block the absorption of cholesterol from the digestive tract. Consuming more than this amount, however, won't lower cholesterol any further. It's important to note that the cholesterol-lowering effect of plant sterols and stanols is in addition to statins; however, if a cholesterol absorption inhibitor, such as ezetimibe, is used, these supplements are probably of limited benefit.

The Food and Drug Administration has allowed manufacturers of products enriched with a specified amount of plant sterols or stanols (at least 0.65 g of plant sterol esters or at least 1.7 g of plant stanol esters per serving) to claim effectiveness in lowering blood cholesterol when eaten twice a day as part of a diet low in saturated fat and cholesterol.

Consuming more fiber can also help lower cholesterol. Read on to learn how psyllium, a natural, soluble fiber, can help reduce total cholesterol.

Psyllium is a natural, soluble fiber derived from the husks of psyllium seeds. It is the active ingredient in laxatives, such as Metamucil, and may be used to enrich foods, such as ready-to-eat cereal. For decades, psyllium has been prescribed by doctors to prevent constipation or to regulate bowel habits in patients with irritable bowel syndrome, diverticular disease, or hemorrhoids. However, in recent years, psyllium has been shown to lower blood cholesterol; it is thought to stimulate the conversion of cholesterol into bile acid and then increase bile acid excretion. It may also decrease the intestinal absorption of cholesterol.

A review of eight clinical studies found that people with mild to moderately high blood cholesterol, who ate a low-fat diet and consumed 10.2 g of psyllium a day for over eight weeks, reduced total cholesterol by four percent and LDL cholesterol by seven percent, as compared with those who ate a low-fat diet but did not consume psyllium. In studies using psyllium-enriched cereal that provided about 10 to 12 g of psyllium a day, total cholesterol dropped five percent and LDL cholesterol dropped nine percent more than the reduction achieved with a low-fat diet alone. In fact, at least 7 g of soluble fiber from psyllium a day are needed for heart-healthy benefits. However, it may cause intestinal gas if too much is consumed too quickly. You may need to build up the dosage. Psyllium should also be taken with adequate amounts of fluids.

Whole grains are another major source of dietary fiber. See the next page to find out more about how whole grains can help lower cholesterol.

Whole grains include all three parts of the grain kernel: bran, germ, and endosperm. The bran is the outer covering that protects the seed. It contains fiber, B vitamins, and minerals. The germ contains the embryo, which, if fertilized, will sprout into a new plant; it contains B vitamins, vitamin E, minerals, and some protein. Both the germ and the bran contain many phytonutrients -- health-promoting plant compounds -- including polyphenols, phytoestrogens, and antioxidants. The endosperm is the largest part of the kernel, which supplies energy to the growing seedling. It contains carbohydrate, protein, and small amounts of vitamins and minerals. When grains are refined, the bran and some of the germ are removed, leaving the starchy endosperm. Whole grains -- such as whole wheat, whole oats and oatmeal, whole rye, whole-grain barley, brown rice, and popcorn -- provide health benefits that are not found with refined grains, and they protect against heart disease, obesity, diabetes, and cancer.

In fact, evidence suggests that eating three or more daily servings of whole-grain foods may reduce the risk of heart disease by approximately 20 to 30 percent. In a study of nearly 43,000 men, those who ate the most whole grains had an 18 percent lower risk of heart disease than those who ate the least. Eating bran made an even greater difference; the group that ate the most bran had a 30 percent lower risk of heart disease than those who didn't eat bran. In a study of more than 200 women with heart disease, those who ate six or more servings of whole grains a week had less buildup of plaque in their arteries that those who ate whole grains less often.

The way in which whole grains protect the heart is not fully understood; the fiber in whole grains may be responsible for protecting the heart. Or other compounds, such as phytoestrogens and antioxidants, may be beneficial in lowering cholesterol and the risk of heart disease. Diets rich in whole grains have been linked to a lower risk of metabolic syndrome and decreased insulin resistance. The Food and Drug Administration allows manufacturers of food products that contain 51 percent or more whole grains to claim that diets rich in whole-grain and other plant foods and low in total fat, saturated fat, and cholesterol may help reduce the risk of heart disease and certain cancers. The Dietary Guidelines for Americans 2005 recommends an intake of at least 3 ounces of whole grains every day, but most Americans only eat about one serving a day.