Lower Your Cholesterol Naturally Through Diet and Exercise

“A plant-based diet, rich in fruits, vegetables, beans, lentils, and whole grains, offers the surest path to a low cholesterol” 

Neal Barnard, M.D., Washington

Cholesterol (from Ancient Greek: chole- [bile], stereos [solid], –ol [chemical suffix for an alcohol]) is a soft, waxy substance, a steroid lipid (fat) actually, found in all parts of the body, including the bloodstream, central nervous system, skin, muscle, liver, intestine, and heart. Our liver manufactures all the cholesterol we need, so it is not necessary to consume it in the diet. The liver produces 75% of the cholesterol that circulates in our blood. The other 25% comes from food including animal products. Foods of plant origin (vegetables, fruits, grains, cereals, legumes and lentils, nuts, and seeds) contain no cholesterol.

While there can be negative health benefits associated with low cholesterol, cholesterol deficiency is rare. But cholesterol levels are precariously high in more than 100 million Americans. High levels of cholesterol and cholesterol consumption have been correlated with an increased risk of heart disease and stroke. Since cholesterol is only found in animal food products, vegans tend to have lower cholesterol levels than non-vegans. Consequently, cholesterol lowering foods should be incorporated into everyone’s diet for optimal health.

Cholesterol is important for health because it is:

• A critical component of animal cell membranes (the outer coating of cells) which enable proper membrane permeability and fluidity.
• Converted into bile in the liver. The bile is stored in the gallbladder. When you eat, bile acids (salts) in the bile help digest food in your intestine and allow fat and fat-soluble vitamins A, D, E, and K to be absorbed.
• A precursor molecule for the synthesis of Vitamin D and steroid hormones, including adrenal gland hormones, cortisol and aldosterone, as well as sex hormones estrogen, progesterone, and testosterone.
• Important in brain development and for facilitating connections between brain cells (synapses), making it essential to learning and memory.
• Transported in the blood to be used by all parts of the body.

Without cholesterol, these functions could not take place, and human beings wouldn’t exist. Note that some of the most nutritious foods like egg yolks and liver are also the foods richest in cholesterol.

Why the concern about cholesterol?

A high level of cholesterol is one of the major risk factors for atherosclerosis (coronary artery disease), heart attacks, strokes, and Alzheimer’s disease. Since cholesterol is present in animal-based foods which also tend to be high in saturated fat and trans fat, cholesterol may simply be associated with, though not the direct cause of, these pathologies. Excess cholesterol and saturated animal fat (which also contains some trans fat) in the bloodstream can promote a build-up of plaque inside and on the walls of arteries that eventually narrows these arteries. This is dangerous, because artery narrowing can restrict blood flow to various organs. If the blood supply to part of your heart or brain is significantly reduced or completely cut off, the result is a heart attack or stroke.

Family history and cholesterol levels: Cholesterol comes from two sources, the body and food, and either one can contribute to high cholesterol. Some people inherit genes that trigger too much cholesterol production, resulting in a condition called “hypercholesterolemia.” For others, diet is the main culprit. Saturated fat and cholesterol occur in animal-based foods, including meat, eggs, and dairy products. In some cases, high cholesterol stems from a combination of an unhealthy diet and genetics.

Good cholesterol versus bad cholesterol: Up to a third of blood cholesterol is carried by high-density lipoproteins (HDL). HDL is called “good cholesterol” because it helps remove “bad cholesterol,” low-density lipoproteins (LDL), preventing the latter from building up inside arteries. The higher the level of HDL cholesterol, the better. People with too little HDL and too much LDL are more likely to develop atherosclerosis and heart disease. Eating healthy fats, such as olive oil, may help boost HDL cholesterol.

Factors associated with an increased risk of high cholesterol:

• A diet high in animal-based foods, saturated fats, trans fats, and cholesterol
• A family history of high cholesterol blood levels or hypercholesterolemia
• Being overweight or obese
• Sedentary lifestyle
• Smoking
• Getting older

Recommendations: More than half of the adult population has blood cholesterol levels higher than the desirable range. High cholesterol levels often begin in childhood. Some children may be at higher risk due to a family history of high cholesterol. In general, your total cholesterol should be less than 200 milligrams per deciliter (mg/dl), since that level carries the least risk of heart disease. Above that level the risk for heart disease increases. Ask your health care provider about your HDL and LDL levels, as well as, what your cholesterol levels indicate.

Cholesterol and children: Cholesterol can begin clogging arteries during childhood, leading to atherosclerosis and heart disease later in life. Recommendations for children’s diets are similar to those of adults. However, it is very important that children get enough calories to support their growth and activity level, and achieve and maintain a desirable body weight. The American Heart Association recommends that diet and exercise be used to help reduce high cholesterol levels in children and teenagers. Ideally, total cholesterol should be below 170 mg/dl in people ages 2 to 19.

To lower high cholesterol levels:

• Become more physically active and include safe, moderate exercise in your schedule more often: First talk to your doctor before beginning any exercise program. Regular, moderate exercise, including aerobics, increases the flow of nutrients and oxygen throughout the body, improves concentration and muscle mass, and can help reduce your weight, blood pressure, diabetes risk, and levels of cholesterol, triglyceride, and cortisol stress hormone. Moderate exercise may also reduce build-up inside coronary arteries and thereby improve blood flow. Choose a safe activity that boosts your heart rate, such as walking briskly, dancing, swimming, gardening, using stairs instead of an elevator, hiking, biking, or running. Aim for at least 30 minutes, or two 15-minute sessions if that is easier to schedule, on most days of the week.
• Talk with your doctor about a safe weight loss program if you are overweight: Losing weight can help raise HDL levels and lower triglyceride, LDL, and total cholesterol levels.
• Gradually increase your intake of both dietary fiber and water to help flush the fiber through your digestive tract and reduce cholesterol: Soluble fiber helps lower LDL cholesterol by interfering with absorption of dietary cholesterol from your digestive tract. Good sources include oatmeal, oat cereal, beans, lentils, dried peas, apples, oranges, pears, oat bran, strawberries, nuts, flaxseeds, blueberries, psyllium, cucumbers, celery, and carrots.
• Eat more plant foods including fruits, vegetables, beans, lentils, whole grains, nuts and seeds (for soluble and insoluble fiber) and fewer foods from animals (low in fiber).
• Check food labels and select items low in saturated fat, cholesterol, trans fat, and sugar. 
• Consume heart-healthy fats sparingly:* Olives, olive oil, vegetable oils, avocado, nuts and seeds, simple, unflavored nut butters, and the oils that come from nuts provide polyunsaturated and monounsaturated fats. All fats contain about the same number of calories, so consume them in moderation for easier weight management.
• Avoid unhealthy fats: No more than 35% of your daily calories should come from fat. But not all fats are healthy. Saturated fats from animal products and tropical oils raise LDL. Trans fats raise LDL and lower HDL! These artery-clogging fats are found in many meats, cold cuts, partially hydrogenated oils, processed foods, prepackaged mixes, baked goods, pastries, fried foods (doughnuts, fries, chips), butter, solid shortenings like Crisco, stick margarine, chocolates, cookies, and snack foods.
• Limit total fat intake to 25-35% of total daily calories: Less than 7% of daily calories should be from saturated fat, not more than 10% should be from polyunsaturated fat, and not more than 20% from monounsaturated fat.
• Eat less than 200 mg of dietary cholesterol per day.
• Eat smaller portions of meat, about the size of a deck of cards.
• Choose lean protein: Meat and full-fat milk offer plenty of protein, but they are also major sources of cholesterol. Select low-fat or non-fat dairy products. Reduce LDL cholesterol by switching to quinoa (a whole grain which provides complete protein) or soy protein such as edamame and tofu, or eat beans or lentils with whole grains like rice or whole wheat pasta at some meals. Many fish, like Arctic Char and wild Alaskan salmon, are healthy and rich in omega-3 fatty acids, which can improve cholesterol levels. The American Heart Association recommends eating fish at least twice a week.
• Select meat with the least amount of visible fat and trim fat from the edges of the meat.
• Remove all skin from poultry before cooking.
• Remove all skin from cooked fish, unless it can be removed prior to cooking.
• Stop smoking: Smoking lowers HDL levels. The American Heart Association reports that quitting smoking can increase HDL by up to 10-20%. In contrast to HDL’s positive effects, LDL cholesterol promotes cellular damage to the interior of blood vessel walls and storage of cholesterol as plaque inside artery walls. Exposure to smoke, whether by actively smoking or breathing secondhand smoke, causes LDL to bind more effectively to artery walls. Talk with your health care provider about which smoking cessation strategies may be best for you.
• Avoid “simple carbohydrates” like sugar, dextrose, maltose, maltodextrin, corn syrup, high fructose corn syrup, beet sugar: Diets low in simple carbohydrates may be better than low-fat diets for improving cholesterol levels. In a two-year study funded by the National Institutes of Health, people who followed a low-carb plan had significantly better HDL  levels than those who followed a low-fat plan.

Food sources naturally high in cholesterol: 

• Egg yolks
• Dairy products
• Meats
• Organ meats such as liver, kidney, sweetbread, and brain
• Poultry
• Fish generally contains less cholesterol than other meats, but some shellfish (oysters, clams, mussels, etc.) are high in cholesterol.

Cholesterol-rich foods, like eggs, shrimp, and lobster are no longer completely forbidden. Research shows that the cholesterol we eat has only a small effect on blood cholesterol levels for most people. Some people are “responders,” whose blood levels spike up after eating eggs. But for most, saturated fat and trans fats are bigger concerns. Daily cholesterol limits are 300 mg for healthy people and 200 mg for those at higher risk. One egg has 186 mg of cholesterol.

Fat content is not a good measure of cholesterol content. For example, liver and other organ meats are low in fat, but very high in cholesterol.

Healthy foods which help to lower LDL cholesterol naturally, while preserving HDL cholesterol:

• Fish
• Whole grains
• Oat bran: Proven effective in lowering LDL cholesterol levels. Add bran to hot cereals, non-fat yogurt, and bread.
• Whole barley or buckwheat: Like the bran from oats and rice, barley reduces cholesterol, particularly when it is used as a substitute for wheat products. Barley can easily substitute for wheat in the form of barley noodles, barley flour, or whole pearl barley.
  
• Plain old-fashioned oatmeal or steel-cut oats
• Brown rice
• Garlic: Less than half a clove (900mg) of raw garlic a day can lower cholesterol. Raw garlic is best and can be added to olive oil salad dressings, or as a garnish on soups and sandwiches.
• Blueberries
• Cranberries
• Avocados
• Olives
• Broccolli
• Brussels sprouts
• Cauliflower
• Carrots
• Apples
• Pears
• Raspberries, blackberries
• Nuts and seeds, including walnuts, almonds, hazelnuts, pecans, pistachios, flaxseeds, pumpkin seeds, sesame seeds, sunflower seeds (Since these are calorically dense, eat no more than 1/4-1/2 cup at a time. Add them to baked goods, cooked whole grains, cottage cheese, yogurt, and hot cereals like oatmeal)
• Beans and legumes
• Soybeans and soy products
• Low-fat or non-fat yogurt with live active cultures
• Green tea (without sugar)
• Monounsaturated and polyunsaturated fats: Substituting saturated animal fats and other high cholesterol foods with healthier fats like olive oil, canola oil, peanut oil, nuts and seeds, olives, and avocados can help you reduce your LDL cholesterol.
• 100% grape juice
• 100% cranberry juice
• 100% pomegranate Juice

Foods to avoid (or limit) if you already have high cholesterol or want to keep it relatively low: 

• Foods with tropical oils such as coconut, palm, or palm kernel
• Foods high in saturated fats, cholesterol, and/or trans fats
• Butter, lard, shortening: Common in cakes, cookies, breads, pre-packaged vegetables with sauce included, etc. [100 grams of butter contains 215mg (72% DV) of cholesterol; one stick contains 243mg (81% DV) cholesterol, and one tablespoon contains 30mg (10% DV)]
• Fatty red meats, pork, veal
• Organ meats (brain, kidneys, liver, sweetbreads, etc.)
• Pate, Foie gras
• Bacon
• Most fast food meals: Fast food biscuits, breakfasts, burgers, and sandwiches are packed with cholesterol. A ham, egg, and cheese biscuit will provide 172mg (57% DV) per 100g serving, or 246mg (82% DV) of cholesterol per biscuit. An egg and sausage biscuit has even more with 261mg (87% DV).
• Cheese: Port de Salut contains the most cholesterol with 123mg (41% DV) per 100 gram serving. That is 21mg (7% DV) per one inch cube. Other cheeses high in cholesterol include: Fontina (39% DV), Gouda (38%), Cream Cheese (37% DV), Gruyere (37%), and Cheddar (35% DV).
• Whole milk, milk products that contain more than 1% milkfat, cream, half-and-half, heavy whipping cream
• Whole milk yogurt, cheeses, and ice cream
• Egg yolks: The yolks of eggs have the most cholesterol of any food with 1234mg per 100 gram serving or 411% of the DV. A single egg yolk will provide 210mg (70% DV) of cholesterol, while a whole egg provides slightly more with 212mg (71% DV). Thus all the cholesterol in eggs is found in their yolks.
• Cookies, cakes, pies, brownies, mousse, soufflees, etc.
• Pastries (Cream puffs, croissants, eclairs, danish, etc.)
• Muffins
• Crab, lobster, shrimp, prawns, camarones, mussels, scallops, oysters, clams, squid (calamari), octopus
• Fish roe (caviar)
• Processed meats (Beef stick snacks, liverwurst, pepperoni, salami, sausage, lamb, duck): The amount of cholesterol in any processed meat depends on the cut used, and the amount of fat added during processing. Liver sausage and bratwurst will contain around 158mg (50% DV) of cholesterol per 100 gram serving. That is 63mg (21% DV) per link. In terms of meats, lamb and duck will contain the most cholesterol all things being equal.
• Chicken skin
• Fried foods
• Oil-packed fish: Although generally good for your heart, the oil of certain fish, and some oil-packed fish may contain quite a bit of cholesterol. Oil-packed Atlantic Sardines carry 142mg (47% DV) of cholesterol per 100g. That is 131mg (44% DV) per can, and 17mg (6% DV) in a single sardine.

In many cases, substitutions can help reduce the cholesterol content in a meal. For example, using non-fat or low-fat milk, cottage cheese, and low-fat cheese, instead of whole milk, butter, and regular cheese for a macaroni and cheese dish can cut the cholesterol of your recipe in half.

Cholesterol levels may vary greatly between food products. Always read nutrition labels for the exact amount of cholesterol in each individual product.

Cholesterol also varies greatly between cuts of meat. Ask for low-fat lean cuts which will greatly reduce the amount of cholesterol. For chicken and turkey, white meat has less cholesterol and fat than dark cuts such as the leg and thigh.

Low-fat cooking techniques:

• Grilling
• Broiling
• Baking
• Roasting
• Steaming
• Cook food without butter in a good-quality nonstick pan, or use some olive oil, low-sodium broth, or water, to reduce sticking in a stainless steel pan.

Regardless of whether you have high cholesterol, have your cholesterol checked once every five years. People with higher cholesterol levels may need to have their levels checked more often. The same is true for individuals who have certain risk factors for heart disease such as smoking, diabetes, high blood pressure, obesity, or a family history of heart disease.

If you haven’t had your cholesterol checked for some time, be sure to ask your doctor for a blood test called a lipid profile, a simple blood sample taken from the finger or arm to determine your cholesterol levels.

Can damage to arteries be reversed?

It takes years for high cholesterol to clog arteries with plaque. But there is evidence that atherosclerosis can be reversed, at least to some degree. Dean Ornish, MD, has published several studies showing that a low-fat vegetarian diet,  stress management, and moderate exercise can help reduce the build-up inside the coronary arteries. Other research supports the idea that big drops in cholesterol can somewhat help open clogged arteries.

Two ways to reduce cholesterol oxidation:

Have as little cholesterol circulating in your blood as possible. After all, if cholesterol particles are not there, they cannot oxidize. A plant-based diet is the surest path to a low cholesterol.

Consume such an abundance of antioxidants that cholesterol oxidation is inhibited. Again, a plant-based diet rich in fruits, vegetables, beans, and whole grains comes to the rescue.

* Fats are an extremely concentrated form of energy, providing more calories per gram (9 calories per gram) than do carbohydrates (4 cal./g) and protein (4 cal./g) combined. Digestion breaks fats down into fatty acids, which can be stored in muscle and other body tissues. There is no limit to how much fat your body can store!

References:

1. (Source: http://www.healthaliciousness.com/articles/foods-which-lower-cholesterol.php#6T4s1DS8Rodtc8qr.99)         
   
2. Neal Barnard, M.D., Washington. “Plants to the Rescue.” Science Times (Letters to the Editor): The New York Times. Page D6. 12/24/13.