Controlling Cholesterol

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Almost every adult living in an industrialized nation develops some degree of atherosclerosis, commonly known as �hardening of the arteries.� In the U.S., many children have fatty streaks, or �pre-atherosclerosis,� in their arteries. Atherosclerosis leads to strokes, heart attacks, and other serious health problems.

Heart disease is linked to risk factors. The principal risk factors are high cholesterol levels, smoking, and high blood pressure. Other risk factors include: diabetes, obesity, family history of heart disease, and stress. Following is an overview of how food choices can affect one�s cholesterol level.

Every animal cell, both human and nonhuman, contains cholesterol. Cholesterol is important in some cell functions, and the liver produces all of the cholesterol the body needs. There is no need to consume any in one�s diet.

Cholesterol and fats move through the body in protein packages called lipoproteins. Low density lipoproteins (LDLs) carry cholesterol to the organs through the arteries. The LDLs deposit their loads through the inner walls of the arteries. This process encourages the growth of deposits, called plaques, on the artery walls which narrow the artery and obstruct the flow of blood. This is atherosclerosis. If the blood flow to the heart is blocked, a heart attack can occur. If the blood flow to the brain is blocked, a stroke can occur. Since LDLs promote atherosclerosis, they are known as �bad cholesterol.� The higher the LDL level, the higher the risk of heart problems.

�Good cholesterol,� found in high density lipoproteins (HDLs), moves back to the liver where it is disposed of. People who exercise, don�t smoke, and stay at their ideal weight tend to have higher levels of HDLs. Since the majority of cholesterol is in the form of LDLs, a high blood cholesterol level means high LDL levels. Blood cholesterol levels are affected by many factors. But even people with a hereditary tendency toward heart disease can do something about their cholesterol levels. This is very important because with every 1 percent reduction in total blood cholesterol, there is about a 2 percent reduction in the risk of heart attack.¹ Population groups with an average cholesterol level of 150 or less are largely free of atherosclerosis. For cholesterol levels above 150, the risk of heart disease increases.² Following are some guidelines for lowering blood cholesterol:

Decrease Fat Intake, Especially Saturated Fats

Saturated fats raise cholesterol levels, but are easy to avoid. Saturated fats are solid at room temperature. They are found predominately in animal products but are also found in a few vegetable oils, such as palm oil, coconut oil, chocolate, and hydrogenated oils.

Decrease Cholesterol Intake

Cholesterol in foods increases levels of LDLs.³ Cholesterol is found only in animal products. Meat, fish, poultry, dairy products, and eggs all contain cholesterol, while plant products do not. Choosing lean cuts of meat is not enough; the cholesterol is mainly in the lean portion. Many people are surprised to learn that chicken contains as much cholesterol as beef. Every four-ounce serving of beef or chicken contains 100 milligrams of cholesterol. Most shellfish are very high in cholesterol. There is no �good cholesterol� in any food. Cholesterol in foods raises the cholesterol level in one�s blood. The best thing to do is to keep one�s fat intake very low and to avoid all animal products.

Go Vegan

As suggested above, basing one�s diet on plant foods�grains, beans, vegetables, and fruits�is the best way to keep saturated fat intake low and to avoid cholesterol completely. A vegan diet is free of all animal products and yields the lowest risk of heart disease. One study showed that people who adopt a vegetarian diet reduce their saturated fat intake by 26 percent and achieve a significant drop in cholesterol levels in just six weeks.⁴ Besides the very low levels of fat eaten in a typical vegetarian diet, vegetable protein also helps decrease risk for heart disease. Studies have shown that replacing animal protein with soy protein reduces blood cholesterol levels even when the total amount of fat and saturated fat in the diet remain the same.⁵

Fiber: The Added Advantage of a Vegetarian Diet

Soluble fiber helps to slow the absorption of some food components such as cholesterol. It also acts to reduce the amount of cholesterol the liver makes. Oats, barley, beans,⁶ and some fruits and vegetables are all good sources of soluble fiber. There is no fiber in any animal product.

Maintain Your Ideal Weight

Losing weight helps to increase HDL levels (the �good cholesterol�). Carrying excess weight can affect one�s risk for heart disease. People who are thick around the middle (�apple-shaped�) are at a higher risk than those who carry excess weight around the hips and buttocks (�pear-shaped�).⁷ �Apple-shaped� people should lose weight through a low-fat diet and aerobic exercise.

Eat Lots of Small Meals

People who eat frequently throughout the day have lower cholesterol levels. In one study, men consumed either 3 meals a day or 17 snacks a day. The snackers experienced a reduction in cholesterol levels in comparison to the three-meal-a-day group.⁸

Reduce Stress

Mental stress causes an increased release of adrenaline which may elevate blood cholesterol levels. Relaxation techniques such as stretching, deep breathing, or meditation help in lowering blood cholesterol.

Exercise

Aerobic exercise raises levels of HDL-cholesterol and may also reduce levels of LDLs. Exercise also has other benefits for the heart: it strengthens the heart muscle, promotes weight loss, and lowers blood pressure. Exercise can also help reduce stress. Exercise does not have to be terribly vigorous A daily half-hour walk is helpful.

Avoid �Miracle Cures�

Some people have been promoting fish oil supplements as a means to reduce blood cholesterol. However, studies show that they do not lower cholesterol levels. While they may affect triglycerides (fats in the blood), they also may change the overall pattern of lipoproteins in one�s blood in a way that is not beneficial.⁹ A diet including fish is not as beneficial as a pure vegetarian diet.

There have also been reports that alcohol raises one�s levels of HDLs. But recent studies have shown that alcohol does not raise the type of HDL that protects against heart disease. Alcohol address extra calories to the diet and increases the risk for some forms of cancer.

Avoid Tobacco

Tobacco poisons one�s heart as well as lungs.

It's All Tied Together

In order to stop and to reverse atherosclerosis, it is important to take all of these guidelines to heart. Making only modest changes yields only modest results. A low-fat, vegetarian diet coupled with exercise, smoking cessation, and stress reduction program is the best way to lower one�s cholesterol levels and can even reverse heart disease for many people.¹⁰ Well-documented information can be found in Foods That Fight Pain; Eat Right, Live Longer; and Food for Life by Neal Barnard, M.D., and Dr. Dean Ornish�s Program for Reversing Heart Disease by Dean Ornish, M.D.

References
1. National Institutes of Health Consensus Development Conference Statement. Lowering Blood Cholesterol to Prevent Heart Disease.
2. Pooling Project Resource Group. Relationship of blood pressure, serum cholesterol, smoking habit, relative weight and ECG abnormalities to incidence of major coronary events: final report of the Pooling Project. J Chronic Dis 1978;31:201-306.
3. Johnson C, Greenland P. Effects of exercise, dietary cholesterol, and dietary fat on blood lipids. Arch Intern Med 1990;150:137-41.
4. Masarei JR, Rouse IL, Lynch WJ, Robertson K, Vandongen R, Beilin LJ. Vegetarian diet, lipids and cardiovascular risk. Aust NZ J Med 1984;14:400-4.
5. Carroll KK, Giovannetti PM, Huff MW, Moase O, Roberts DC, Wolfe BM. Hypocholesterolemic effect of substituting soybean protein for animal protein in the diet of healthy young women. Am J Clin Nutr 1978;31:1312-21.
6. Swain JF, Rouse IL, Curley CB, Sacks FM. Comparison of the effects of oat bran and low-fiber wheat on serum lipoprotein levels and blood pressure. N Engl J Med 1990;322(3):147-52.
7. Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U. Impact of obesity on metabolism in men and women: importance of regional adipose tissue distribution. J Clin Invest 1983;72:1150-62.
8. Jenkins DJ, Wolever TM, Vuksan V, et al. Nibbling versus gorging: metabolic advantages of increased meal frequency. N Eng J Med 1989;321:929-34.
9. Grundy SM, Denke MA. Dietary influencees on serum lipids and lipoproteins. J Lipid Res 1990;31:1149-72.
10. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes reverse coronary heart disease? Lancet 1990;336:129-33.