Cholesterol

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Cholesterol

27 Ways to Stay on the Low Side

It's not bad enough that your cheeks are chubby and your waist's a tad wide. Now your doctor says that even your blood is too fat! Well, that's not exactly what he said, but he might as well have. When your cholesterol levels are high, you've got too much of a mushy, yellow, fat-related substance circulating in your bloodstream. If the excess builds up on artery walls, it can clog your arteries and restrict blood flow, possibly leading to a heart attack, stroke, or angina pain. And you don't need a medical degree to know that's not good.

Funny thing is, cholesterol isn't all bad. Your body naturally produces it, and it performs some pretty vital jobs—helping to build new cells, produce hormones, and insulate nerves. Only when you've got too much do you have a problem.

Unfortunately, there's a lot of confusion surrounding this substance. And it's no wonder, with similar terms like dietary cholesterol, serum cholesterol, HDL cholesterol, and LDL cholesterol being bandied around, you may have trouble telling the good from the bad and the ugly. Here's how to keep them all straight.

Dietary cholesterol is what's contained in food (mostly of animal origin). One egg, for example, has 275 milligrams; an apple has none. The American Heart Association (AHA) recommends that you limit your daily intake to 300 milligrams.

Serum cholesterol is what's in your bloodstream and what your doctor measures with a cholesterol test. A reading under 200 is desirable.

HDL (high-density lipoprotein) cholesterol is a subdivision of serum cholesterol that is considered good for its artery-scouring ability. The higher your levels of HDL, the better.

LDL (low-density lipoprotein) cholesterol is HDL's artery-clogging evil twin. The lower your levels, the better.

Here's how the experts say you can lower your serum cholesterol levels.

Supplements That Counter Cholesterol Can nutritional supplements lower cholesterol? Some researchers seem to think so. Here's a rundown on the supplements that have shown the most promise. But before you increase your supplemental intake of any nutrient, talk it over with your doctor. Niacin. "Large doses of niacin (also known as nicotinic acid) may lower both total cholesterol and LDL cholesterol," says famed researcher Kenneth Cooper, M.D., of Dallas, Texas. "It's best to start off with low doses, say up to 100 milligrams a day. Then increase gradually over a period of several weeks to 1 or 2 grams three times a day, for a total of 3 to 6 grams daily." But be aware that sudden drastic increases in niacin can produce severe overall flushing, intestinal disorders, and sometimes abnormal liver function, warns Dr. Cooper. Be sure to discuss this treatment with your doctor. Niacinamide, a form of niacin that doesn't cause flushing, has no significant effect on blood fats. Vitamin C. Tufts University researcher Paul Jacques found that vitamin C raised levels of protective HDL in the elderly people he studied. He estimates that 1 gram a day could increase HDL by 8 percent. Other studies show that when extra vitamin C is added to a pectin-rich diet, cholesterol drops even lower than with pectin alone. Conveniently, many pectin-packed fruit and vegetables—such as citrus fruit, tomatoes, potatoes, strawberries, and spinach—are also rich in vitamin C. Vitamin E. One study done by French and Israeli researchers showed that 500 international units of vitamin E a day for 90 days significantly increased HDL levels. "Our results support the use of vitamin E for people with high blood-fat levels," said the researchers. Calcium. If you're taking calcium supplements for the sake of your bones, you may be doing your heart a favor, too. In one study, 1 gram of calcium daily for eight weeks lowered cholesterol 4.8 percent in people with mildly high levels. In another study, 2 grams a day of calcium carbonate reduced cholesterol by 25 percent in 12 months.

Watch your weight. The more overweight you are, the more cholesterol your body produces. A 20-year study in the Netherlands concluded that body weight is the single most important determinant of serum cholesterol. Every 2.2-pound rise in body weight elevated cholesterol levels 2 points. And the famous Framingham Heart Study also found a definite link between blood cholesterol and body weight.

So if your weight is up, this is one more reason to bring it down. But do so in a healthy way, says Paul Lachance, Ph.D., a professor of food and nutrition at Rutgers State University of New Jersey. "Strive for a diet that's composed of two-thirds fruit, vegetables, cereals, and whole grains. Only one-third of your calories should come from meat and dairy products, which are often high in fat and calories."

Cut the fat. "Three principal dietary factors have an impact on blood cholesterol levels," says John LaRosa, M.D., chairman of the nutrition committee of the AHA and director of the Lipid Research Center at Georgetown University School of Medicine. They are, in order of importance:

• Saturated fat, which elevates blood cholesterol
• Polyunsaturated fat, which lowers blood cholesterol
• Dietary cholesterol, which can contribute to elevated blood cholesterol to a lesser degree than saturated fat

"Of these, saturated fat has by far the greatest impact on cholesterol levels," he says.

Donald McNamara, Ph.D., a professor of nutrition and food science at the University of Arizona, agrees. "The effect of saturated fat is about three times worse than that of dietary cholesterol." So you'd be wise to cut back on such sources of saturated fat as meat, butter, cheese, and hydrogenated oil. Wherever possible, replace these items with fish, poultry, low-fat dairy products, and polyunsaturated oils, such as corn, safflower, and soybean.

Switch to olive oil. Olive oil—and certain other foods like nuts, avocados, canola oil, and peanut oil—are high in still another type of fat: monounsaturated. Previously thought to have no real effect on cholesterol levels, monounsaturates may actually lower cholesterol.

Studies by cholesterol researcher Scott M. Grundy, Ph.D., found that a diet high in mounounsaturated fat lowered total cholesterol levels even more than a strict low-fat diet. What's more, his studies showed that monos selectively lowered the (bad) LDLs while leaving the (good) HDLs intact.

So strive for a low-fat diet, then "supplement" it with 2 or 3 tablespoons of olive oil (or an equivalent amount of other mono-rich food) each day. Just make sure you're replacing other fats with monos and not simply adding to them.

Go easy on eggs. But don't feel you have to cut them out of your diet entirely. Although eggs have a whopping 275 milligrams of cholesterol apiece, Dr. McNamara says that about two-thrids of the population can handle extra dietary cholesterol without experiencing a rise in their serum cholesterol levels. That's because their bodies adjust to a high intake by producing less of their own cholesterol or by excreting the excess. In one study he conducted, 50 patients ate three large eggs a day for six weeks. Less than a third of them had higher cholesterol levels during this time.

If you'd like to eat eggs but still play it safe, limit yourself to three whole eggs a week. Since only the yolks contain cholesterol, you can use egg whites freely, substituting two whites for every whole egg when baking, for example. And you can make omelets and scrambled eggs using one whole egg with two, three, or even four whites. Also, some stores now sell lower-cholesterol eggs, which may contain from 15 to 50 percent less cholesterol than usual.

Be full of beans. Nutritious and inexpensive, beans and other legumes contain a water-soluble fiber called pectin that surrounds cholesterol and chaperones it out of the body before it can cause trouble. Numerous studies by cholesterol researcher and professor of medicine and clinical nutrition James W. Anderson, M.D., of the University of Kentucky College of Medicine, have shown just how effective beans are in lowering cholesterol. In one experiment, men who ate 1 1/2 cups of cooked beans a day lowered their cholesterol a whopping 20 percent in just three weeks.

Dr. Anderson says that most people would do well to add about 6 grams of soluble fiber to their diet each day. A cup of cooked beans fits the bill nicely. And you needn't worry that you'll get bored eating beans because navy beans, kidney beans, pinto beans, lima beans, soybeans, black-eyed peas, and lentils all have this cholesterol-lowering ability.

The Alternate Route Potential Weapons against Cholesterol The following substances may also help combat high cholesterol. Although they've not undergone extensive studies, initial research has been promising. Tea. Or more precisely, the tannins found in it, may help control cholesterol. One study found that people who habitually drank tea on a high-cholesterol diet had blood cholesterol levels within the normal range. Lemongrass oil. A common flavoring in oriental cooking, lemongrass oil lowered cholesterol by more than 10 percent in one study. It may work by interfering with an enzyme reaction and inhibiting the formation of cholesterol from simpler fats. Spirulina. A protein-rich form of algae often sold in powdered or tablet form, Spirulina reduced both total cholesterol and LDL levels in Japanese volunteers with high cholesterol who took seven 200-milligram tablets after every meal. Barley. Long considered a healthful high-fiber grain, barley may have the same cholesterol-lowering potential as oats. In animal studies, two chemical components of barley lowered cholesterol levels by 40 percent. Rice bran. This fiber may prove as effective as its cousin, oat bran. Preliminary studies with hamsters showed that rice bran reduced cholesterol by more than 25 percent. Activated charcoal. Finely ground, this substance, which is often taken to alleviate gas, may latch onto cholesterol molecules in the body and escort them safely out. In one study, patients had a 41 percent drop in LDL levels after taking 1/4 ounce of activated charcoal three times a day for four weeks.

Eat more fruit. Fruit also gets the cholesterol-lowering punch from pectin. Gastroenterologist James Cerda, M.D., of the University of Florida Health Science Center, found that grapefruit pectin (found in the rind and flesh) lowered cholesterol an average 7.6 percent in eight weeks. Since a 1 percent reduction in cholesterol causes a 2 percent drop in the risk of heart disease, Dr. Cerda regards this effect as "quite significant."

To get the amount of pectin Dr. Cerda used, you'd have to eat about 2 1/2 cups of grapefruit sections a day. But if that's a little hard to swallow, he says, "Eat lots of different fruits. If you had half a grapefruit for breakfast, an apple at lunch, and some orange sections for dinner, for example, you could probably lower your cholesterol nicely."

Feel your oats. Oat bran appears to lower serum cholesterol in a fashion similar to pectin-rich fruit. Numerous studies by Dr. Anderson and others show, in fact, that oat bran does as good a job as beans. To get Dr. Anderson's recommended 6 grams of soluble fiber a day, you could eat 1/2 cup of oat bran cooked as cereal or made into muffins. In one California study, medical students who ate two oat-bran muffins a day for four weeks had a 5.3 percent reduction in total serum cholesterol.

Although oat bran has more soluble fiber, oatmeal can also lower cholesterol. According to research at Northwestern University Medical School, when people in one study added 2/3 cup of rolled oats a day to a low-fat, low-cholesterol diet, their cholesterol fell more than on the healthy diet alone.

In response to all these studies, U.S. Department of Agriculture (USDA) scientists are breeding oat varieties that will have even higher levels of beta-glucan, the suspected cholesterol fighter.

Be a little corny. In studies conducted by nutritionist and dietitian Leslie Earil of Georgetown University Hospital, corn bran was as effective as oat bran and beans in lowering cholesterol. People with high cholesterol who had previously tried to control it with a low-cholesterol diet and weight reduction ate about 1 tablespoon of corn bran at each meal (mixed into soup or tomato juice). After 12 weeks, their cholesterol levels dropped a significant 20 percent. "This abundant low-calorie fiber is worthy of much more investigation," says the study.

Call on carrots for help. Carrots can lower cholesterol, also by way of their pectin content, says Peter D. Hoagland, Ph.D., of the USDA's Eastern Regional Research Center in Philadelphia, Pennsylvania. In fact, he says, "it may be possible for people with high cholesterol to lower it 10 to 20 percent just by eating two carrots a day." That could be enough to bring many people's levels into the safe range.

Incidentally, cabbage, broccoli, and onions also contain the ingredient thought responsible for carrots' success (calcium pectate) and may produce similar results, according to Dr. Hoagland.

Exercise! It's possible that exercise can decrease the buildup of cholesterol blockage inside arteries, says Rhode Island cardiologist Paul D. Thompson, M.D., an associate professor of medicine at Brown University. "One of the best ways to raise your levels of protective HDL," he maintains, "is through vigorous exercise, which also modestly lowers your levels of undesirable LDL.

"Exercise might also increase the body's ability to clear fat from the blood after meals," he says. "If the fat doesn't stay in the blood very long, it has less opportunity to build up on artery walls. We've found that runners are able to clear fat from their systems 70 percent faster than other people who don't exercise." So get moving!

Beef up your diet—sensibly. Here's a surprise. Red meat, a notorious source of saturated fat, can be part of a heart-healthy diet—if it's lean to begin with and then trimmed of all visible fat. British researchers put men with extremely high cholesterol on a low-fat, high-fiber diet containing 6 1/2 ounces a day of very lean red meat. The fat content of this diet was 27 percent of total calories, which is well below the 40 percent currently consumed by most people in the United States. The men's cholesterol levels fell by a respectable 18.5 percent.

The researchers concluded, "Provided care is taken to reduce the fat content substantially, a moderate quantity of meat products may be included in a cholesterol-lowering diet."

Get a health kick from skim milk. From Aura Kilara, Ph.D., associate professor of food science at Pennsylvania State University, comes this suggestion: Drink lots of skim milk. In one experiment he conducted, volunteers added a quart of skim milk to their daily diets. At the end of 12 weeks, those with elevated cholesterol levels lowered them an average of 8 percent. Dr. Kilara believes a compound in the nonfat portion of the skim milk did the trick by inhibiting cholesterol production in the liver.

Take garlic. Researchers have long known that large quantities of raw garlic can reduce harmful blood fats. Unfortunately, raw garlic can also reduce your circle of friends. Worse yet, garlic that's been "deodorized" by heat treatment loses its cholesterol-lowering effects. But now there's an odor-modified liquid garlic extract from Japan called Kyolic that seems to lower blood fats.

When Benjamin Lau, M.D., of Loma Linda University in California, gave people with moderately high blood cholesterol 1 gram a day of the liquid garlic extract, their cholesterol levels fell an average of 44 points in six months.

Try this special seed. Fiber-rich psyllium seeds, the main ingredient of the bowel regulator Metamucil, may also lower cholesterol. In a study by Dr. Anderson, men with elevated cholesterol who took a teaspoon of Metamucil in water three times a day lowered their levels about 15 percent in eight weeks.

Dr. Anderson says Metamucil and other psyllium-seed products may be a good auxiliary treatment when diet alone doesn't bring blood cholesterol levels down.

Cut back on coffee. A study conducted by Texas researcher Barry R. Davis, M.D., has linked coffee consumption with increased cholesterol. When he studied over 9,000 people as part of a nationwide blood pressure program, he found that cholesterol levels were dramatically higher in people who drank two or more cups of coffee per day.

Although his study didn't pinpoint the ingredient in coffee that's responsible, a Finnish study showed that boiling (or perking) coffee may be part of the problem. coffee prepared by the filter method did not increase cholesterol levels in the same way perked coffee did. In any case, caffeine—a logical suspect—does not seem to be culprit.

Don't smoke. Here's one more reason to quit smoking. In a study conducted by New Orleans researcher David S. Freedman, M.D., teenage boys who smoked as few as 20 cigarettes a week had substantial increases in blood cholesterol. In addition, a Swedish study showed that smokers tend to suffer from low levels of beneficial HDL cholesterol. When a group of habitual smokers kicked the habit, however, they all experienced rapid and pronounced increases in HDL concentrations.

So relax already. Simple relaxation can lower cholesterol, according to a study done by Margaret A. Carson, a clinical nurse specialist in New Hampshire. She found that heart disease patients on low-cholesterol diets who listened to relaxation tapes twice daily experienced significantly greater drops in cholesterol than another group that simply read for pleasure.

PANEL OF ADVISERS

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James W. Anderson, M.D., is director of the endocrine section of the Veterans Administration Medical Center in Lexington, Kentucky. He is also professor of medicine and clinical nutrition at the University of Kentucky College of Medicine in Lexington. He is one of the foremost experts in cholesterol research.

James Cerda, M.D., is a gastroenterologist at the University of Florida Health Science Center in Gainesville.

Kenneth Cooper, M.D., a medical researcher, is president and founder of The Aerobics Center in Dallas, Texas, and author of Controlling Cholesterol, Preventing Osteoporsis, and other books.

Peter D. Hoagland, Ph.D., is a researcher with the U.S. Department of Agriculture's Eastern Regional Research Center in Philadelphia, Pennsylvania.

Aura Kilara, Ph.D., is an associate professor of food science at Pennsylvania State University in University Park.

Paul Lachance, Ph.D., is a professor of food and nutrition at Rutgers State University of New Jersey in New Brunswick.

John LaRosa, M.D., is director of the Lipid Research Center at George Washington University School of Medicine in Washington, D.C., and chairman of the American Heart Association's Nutrition Committee.

Donald J. McNamara, Ph.D., is a professor of nutrition and food science at the University of Arizona in Tucson.

Paul D. Thompson, M.D., is an associate professor of medicine at Brown University in Providence, Rhode Island, and a cardiologist at The Miriam Hospital there.