Lowering Cholesterol with a Healthier Way of Eating

[Guest guest]

Lowering Cholesterol with a Healthier Way of Eating JoAnn Guest May 18, 2005

14:35 PDT

 

How is high cholesterol defined?

http://www.whfoods.com/genpage.php?tname=asknutr & dbid=103

 

High cholesterol or hypercholesterolemia is defined as total cholesterol

greater than 200 mg/dL with the high risk category greater than 240

mg/dL.

 

At these levels, particularly when the ratio of LDL to HDL cholesterol

is greater than 4:1, risk of cardiovascular disease is significantly

increased.

 

The ratio of LDL: HDL should be at least 4:1 because each HDL can pick

up and transport 4 LDL back to the liver.

 

If I have high cholesterol levels, can a healthy way of eating help me

lower them into a normal range?

Absolutely! In fact, a study published in the July 2003 issue of the

Journal of the American Medical Association in which a whole foods diet

was compared head-to-head with treatment by statin drugs found the whole

foods approach to be so effective that the Comment accompanying this

JAMA article is entitled, " Diet first, then medication for

hypercholesterolemia (high cholesterol). "

 

(For more discussion of recent studies see below: Research Studies

Confirm the Importance of Healthy Foods and Healthy Cholesterol Levels.)

 

 

What foods may help me lower my LDL cholesterol and maintain or improve

my ratio of LDL to HDL to healthier levels, e.g., 175 mg/dL with a 4:1

ratio of LDL:HDL ?

 

A diet low in saturated fats and high in soluble fiber from foods such

as oats, peas and beans (especially soy beans), has been found to lower

elevated levels of LDL and improve the ratio of LDL to HDL.

 

Cold water fish, garlic and onions, olive oil and other sources of

monounsaturated fats have also been shown to lower LDL, while

cranberries, organic soy foods and niacin have been found to raise HDL.

 

Supplemental niacin has also been found to not only help reduce LDL

levels, but to raise levels of protective HDL; however, it is important

that you check with your health care practitioner before taking

supplemental niacin for this purpose.

 

Niacin is available in a number of different forms, one of which may be

significantly more helpful for you than another. In addition, some forms

of niacin may cause unpleasant flushing in some individuals. Your health

care practitioner can help you maximize the benefits and minimize the

potential side effects of supplemental niacin.

 

If you want to lower your cholesterol levels or even if you¡¯ve never

had any problems with high cholesterol and just want to maintain healthy

levels, enjoying a Healthier Way of Eating with the World¡¯s Healthiest

Foods can help keep your cholesterol levels in check.

 

Cholesterol is Not Inherently Bad for the Body:

 

In fact, without cholesterol, your body would be unable to make

hormones, cell membranes or vitamin D. Normally, cholesterol flows

through the blood vessels without causing any damage or the build-up of

atherosclerotic plaques.

 

It¡¯s only if cholesterol becomes oxidized by free radicals in the body

that it can become problematic.

 

That is why eating foods rich in antioxidants is so important. Foods

rich in antioxidants, such as vitamins E, C and beta carotene, can help

prevent the oxidation of cholesterol and the damage it may cause to

blood vessels.

 

(For more information on cholesterol, see below: What is cholesterol,

and why should I be concerned if my cholesterol levels are too high?

What causes high cholesterol?)

 

EAT MORE:

 

Foods for Healthy Cholesterol Levels

Nutrient Foods Benefits

 

Soluble fiber* Oat bran, barley, peas, beans (all types, especially soy)

Lowers LDL and improves ratio of LDL to HDL

 

Niacin* (if LDL levels are already high, supplements may be necessary to

reduce levels)

 

Salmon, tuna, chicken, calf liver, halibut, asparagus, crimini

mushrooms Helps decrease the body's production and increase its

elimination fo cholesterol, prevents oxidation of LDL and can increase

levels of HDL cholesterol

 

Antioxidants:

Vitamin E* Swiss chard, sunflower seeds, spinach, kale, mustard greens

Helps prevent prevent the oxidation of LDL cholesterol

 

Vitamin C* Citrus fruits, broccoli, red bell peppers, kale, Brussels

sprouts, kiwi fruit Helps prevent the oxidation of cholesterol

 

Beta carotene* Carrots, sweet potatoes, winter squash, kale Helps

prevent the oxidation of LDL cholesterol

 

Polyphenols, including pterostilbene Cranberries, grapes, blueberries

Help prevent oxidation of cholesterol and increase levels of HDL

cholesterol

 

Unsaponifiables Brown rice Lowers LDL cholesterol

 

Foods rich in taurine and omega 3 fatty acids (e.g., cold water fish),

monounsaturated fats (e.g., olive oil, avocado, walnuts, almonds) and

the allium family of vegetables (e.g., garlic, onions) can also be

helpful. These foods' cholesterol-lowering benefits are discussed below

under " How Foods Help Lower Cholesterol " .

*Click on link for a complete list of foods rich in these nutrients.

 

AVOID:

Saturated fats and cholesterol Red meat and other animal products Strong

association with atherosclerosis and heart disease

 

Trans-fatty acids (hydrogenated fats) Margarine, coffee creamers, many

processed foods Increase LDL cholesterol and lipoprotein(a) levels

 

Eating a Variety of Cholesterol-Lowering Foods Has Additive Beneficial

Effect

A study published in the October 2004 issue of the British Journal of

Nutrition underscores the additive beneficial effects that result when

foods independently known to lower cholesterol are combined in a healthy

way of eating. In this study of 12 patients with elevated LDL

cholesterol levels, a diet containing soy protein, almonds and other

nuts, plant sterols (also found in nuts), and soluble fiber (in high

amounts in beans, oats, pears) reduced blood levels of all LDL fractions

including small dense LDL (the type that most increases risk for

cardiovascular disease) with near maximal reductions seen after only 2

weeks.

 

Want suggestions for some delicious cholesterol-lowering meals and

recipes?

Just click here for our Atherosclerosis Meal Planner.

 

How do these foods help lower LDL cholesterol and maintain healthy

levels?

Soluble Fiber:

Soluble fiber significantly reduces blood cholesterol levels by several

different mechanisms:

 

Decreasing the absorption of dietary cholesterol

Increasing the removal of bile

Increasing the breakdown of blood cholesterol to produce more bile

Decreasing the activity HMG Co-A reductase, a key enzyme involved in the

production of cholesterol by the liver

First, soluble fiber in the intestines binds to bile from the liver, so

the bile is carried out of the body as waste instead of being

reabsorbed. In order for the body to make more bile, which is necessary

for digestion, it must break down more cholesterol, removing it from the

bloodstream. In addition, because bile is needed for the absorption of

cholesterol from food, binding the bile makes it less able to assist in

cholesterol absorption, so less dietary cholesterol is absorbed from

food as well.

 

Secondly, when normal levels of bacteria are present in the colon, they

are able to break down some of the soluble fiber into what are called

short-chain fatty acids. In addition to being the preferred fuel of

colon cells and thus essential for good colon and digestive health, some

short-chain fatty acids are absorbed into the bloodstream, where they

travel to the liver and decrease the action of HMG Co-A reductase, one

of the main enzymes involved in the production of cholesterol.

 

Diets high in soluble fiber have been shown in some studies to lower

total cholesterol and LDL cholesterol as much as 20-30%. The soluble

fiber used in these studies was the naturally-occurring fiber found in

oat bran, beans, and other food sources. In these same studies, the use

of cooked soy beans, a rich source of both soy protein and naturally

occurring soluble fiber, led to a decrease in total cholesterol of 30%

and a decrease in LDL cholesterol of 35-40%.

 

(For more information, see below: Research Studies Confirm the

Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

 

Cultures in which soy foods constitute a major portion of the diet

typically have much lower rates of heart disease than cultures with a

low consumption of soy. In addition to this epidemiological data,

clinical studies have shown that soy foods are protective against the

development of heart disease and its associated mortality. The

beneficial effects found in these studies are due to an intake of whole

soy foods and not the isolated soy components that are currently

available in supplement form. Soybeans and foods made from them have

been found to significantly decrease the risk of heart disease and heart

attack via several mechanisms. Soy can help prevent the oxidation of LDL

cholesterol and soy foods have been shown to decrease LDL by 35-40% and

total cholesterol levels by 30%, to decrease triglyceride levels, and to

decrease platelet aggregation reducing the risk of blood clots. Soy

foods may also increase levels of HDL (beneficial) cholesterol.

 

Research presented at the 2004 annual meeting of the North American

Menopause Society held October 6-9, 2004 in Washington, D.C., and a

study published in the November 2004 issuye of the American Journal of

Clinical Nutrition suggest that soy offers special cholesterol-lowering

benefits for premenopausal women: the isoflavones in soy appear to work

with a woman's own estrogen to decrease cholesterol and increase bone

mass. For a summary of this research, see below: Research Studies

Confirm the Importance of eating Healthy Foods on Healthy Cholesterol

Levels.)

 

For more information about soy, click Soybeans.; on fiber, click Dietary

Fiber.

 

Niacin:

Niacin, also known as vitamin B3, has been shown to decrease the

activity of HMG Co-A reductase, a primary rate-limiting enzyme involved

in the production of cholesterol, thus causing a decrease in the body¡¯s

production of cholesterol. Niacin also helps increase the breakdown of

cholesterol to bile, decreases the proliferation of smooth muscle cells,

helps to prevent LDL oxidation, reduces platelet clumping, lowers

lipoprotein(a) levels, and can increase levels of HDL by as much as

15-40%. Increasing HDL levels, particularly through diet, can

significantly decrease atherosclerosis progression.

 

Niacin has been shown to decrease cholesterol levels by 10-26% and to

decrease heart attack recurrence by 29%. Niacin given to patients after

a heart attack reduced non-fatal heart attack recurrence by 27% and

decreased long-term overall mortality by 11%.

 

For more information, click Niacin.

 

Vitamin E:

Vitamin E prevents oxidation of LDL cholesterol, prevents the growth of

blood vessel plaques, and has been shown to reduce the risk of heart

attack and deaths related to heart disease.

 

The primary fat-soluble antioxidant in the body, Vitamin E is the

antioxidant found in highest quantities in LDL cholesterol particles,

which it protects from oxidation. As the main antioxidant defender of

lipids (fats) in the body, Vitamin E is responsible for putting a halt

to chain reactions of lipid peroxidation anywhere in the body.

 

Vitamin E has also been shown to decrease platelet clumping, prevent the

rupture of existing atheromas, decrease the migration of macrophages to

atheromas, prevent the inhibition of nitric oxide production, and to

decrease the expression of adhesion molecules on the surfaces of

endothelial cells (which form the outermost layer of blood vessel

walls), thereby reducing the amount of binding that can occur with

monocytes and other immune cells.

 

(For more information, see below: Research Studies Confirm the

Importance of Eating Healthy Foods on Healthy Cholesterol Levels.)

 

Why Whole Foods are Better than Vitamin E Supplements

The potential downside of taking vitamin E as a supplement is that large

amounts have been associated with a possible increase in oxidation. This

is because, in order to prevent the oxidation of fats, the vitamin E

itself must become oxidized. If all of the vitamin E in an LDL particle

becomes oxidized, it is then able to cause oxidation of the LDL

cholesterol. A way to prevent this from happening is to make sure that

enough of the antioxidant vitamin C is available. Vitamin C is very

effective at restoring oxidized vitamin E back to its non-oxidized,

antioxidant form. For this reason, studies recommend that an increase in

vitamin E intake be accompanied by an increase in vitamin C intake.

 

One more caution for those interested in taking supplemental vitamin E.

Because of its ability to decrease platelet clumping and clot formation,

supplemental vitamin E should not be used by those taking blood thinners

unless they are being closely monitored by their doctor. Getting your

vitamin E from foods, however, is highly unlikely to cause such

problems. Just remember to include foods rich in vitamin C (discussed

next) in your meals as well.

 

Vitamin C:

The body's primary water-soluble antioxidant, vitamin C is needed for

the proper function of blood vessels, regenerates vitamin E, and can

help decrease cholesterol levels through several mechanisms. Although

vitamin C is not found in LDL cholesterol particles because it is not

fat-soluble, it does play a large role in the prevention of LDL

oxidation. In addition to restoring antioxidant function to vitamin E,

vitamin C also eliminates many free radicals produced by normal body

metabolism, thus preventing them from damaging cholesterol.

 

Low levels of vitamin C have also been associated with higher levels of

total cholesterol and LDL cholesterol, and lower levels of HDL

cholesterol. Vitamin C is required for the breakdown of cholesterol to

bile in the liver and also for the uptake of LDL cholesterol into cells

for normal use. Vitamin C use is therefore associated with a decrease in

total and LDL cholesterol levels as well as an increase in HDL levels.

These effects seem to be most pronounced in men and tend to take about

six months of increased vitamin C intake to be significant.

 

Low vitamin C levels are associated with an increase in cholesterol

deposition in the aorta, the main artery leaving the heart. Vitamin C

has been shown to decrease the binding of monocytes to atheroma lesions,

thereby reducing the rate of atheroma growth. It is especially

beneficial in preventing the negative effects of smoking on the blood

vessels and heart. Vitamin C also reduces the deactivation of nitric

oxide (a chemical messenger that tells blood vessels to dilate) and

actually increases its production, leading to decreased vessel spasm and

increased vasodilation.

 

For more information, click Vitamin C and see below, Research Studies

Confirm the Importance of Eating Healthy Foods on Healthy Cholesterol

Levels.)

 

Beta Carotene:

Beta-carotene is another antioxidant found in foods. Although it is not

found in high quantities in LDL cholesterol particles, it has been shown

to prevent the oxidation of LDL cholesterol. Beta-carotene, like vitamin

C, is also able to increase vessel dilation and reduce vessel spasm. One

study has shown that patients with the lowest level of beta-carotene

intake had almost twice the risk of having a heart attack compared to

those with the highest intake. The group of patients taking the highest

intake of beta-carotene had about 1/3 the risk of fatal heart attack and

about 1/2 the risk of cardiovascular death as those in the group with

the lowest intake.

 

For more information, click beta-carotene and see below LDL Cholesterol

Protected by Beta-Carotene.)

 

Taurine:

Fish are the best sources of taurine. Cold-water fish such as salmon and

cod are recommended as these are also rich in beneficial omega-3

essential fatty acids.

 

Taurine is an amino acid component of protein particularly common in

fish protein. It has been shown to decrease elevated cholesterol levels

by decreasing the absorption of cholesterol in the intestines in

addition to increasing the conversion of cholesterol into bile, thereby

removing it from the body.

 

Studies have shown that individuals with higher intakes of taurine have

a lower risk of death from ischemic heart disease. To gain the maximum

protective benefit, eat a serving of fish at least 5 days a week.

 

For more information about fish, serving ideas and recipes, click cod,

halibut, salmon, scallops, shrimp, snapper, yellowfin tuna

 

Foods Rich in Omega-3 Fatty Acids

Best Food Sources of Omega-3 Fats: cold-water fish such as salmon and

cod and their oils, flaxseed and its oil, walnuts, and purslane.

 

Frequent consumption of fish, especially cold water fish since these

contain the most omega-3s, is associated with a decreased risk of heart

attack.

A high intake of omega-3 fats, when part of a diet low in saturated fat,

has also been found to help decrease cholesterol.

 

Foods rich in omega-3s should be used to replace foods high in saturated

fats such as meat and dairy products.

 

Monounsaturated Fats:

 

Best Food Sources of Monounsaturated Fats include: extra virgin olive

oil, high oleic sunflower oil, avocado, almonds, cashews, peanuts,

sesame seeds, pumpkin seeds and walnuts.

 

Monounsaturated fats are a unique type of fat found in particularly high

quantities in olive oil. These " stable " fats decrease the oxidation of

LDL cholesterol, help reduce cholesterol levels, and may partly explain

why the ¡°Mediterranean Diet,¡± which is high in monounsaturated fats as

well as whole foods, is protective against heart disease.

 

Studies have revealed that populations that follow the ¡°Mediterranean¡±

diet, which is high in vegetables and whole grains, and low in saturated

fats, but relatively high in total fat due to a high intake of olive

oil, tend to have fairly low rates of cardiovascular disease and its

associated mortality.

 

Based on studies of fat intake and heart disease in many countries, it

would be expected that these populations would have high rates of heart

disease because of the level of fat in their diets. However, the

opposite is true.

 

Recent studies have shown that LDL cholesterol particles that contain

monounsaturated fats, such as from olive oil, are much more " resistant "

to " oxidation " that those that contain high levels of polyunsaturated

fats, such as from other vegetable oils like corn or safflower oil.

 

In addition, the substitution of monounsaturated fats for saturated fats

in the diet has been shown to decrease total cholesterol by 13.4% and to

decrease LDL cholesterol by 18%.

 

The most important aspect of the use of monounsaturated fats is that

they be used in place of saturated fats. Adding olive oil to a diet that

is already high in saturated and/or trans fats can have negative effects

on heart disease progression and risk.

 

Olive oil should instead be used to replace animal sources of fat and

other vegetable oils.

 

Even though olive oil is a relatively stable fat, it is important not to

use olive oil when cooking foods as high temperatures. Exposing even

this more stable oil to high temperatures may cause it to oxidize.

 

Instead, use our Healthy Sauté or Healthy Stir Fry to cook the food,

then after removing it from the heat, add the olive oil. You'll add all

its delicious flavor and health-giving benefits to your food, without

potentially adding damaged fats that might cause damage to the fats,

including cholesterol, in your own body.

 

 

 

Polyphenols, including Pterostilbene

 

Pterostilbene, a powerful antioxidant compound found in cranberries,

grapes and blueberries, activates a type of cell receptor involved in

absorbing lipids, including cholesterol, into cells for use in energy

production.

 

A study published in the July 2004 issue of the Journal of Agricultural

and Food Chemistry found that pterostilbene was as effective as the

lipid-lowering drug ciprofibrate in activating this cell receptor,

called PPAR-alpha.

(For more on this research see below: Research Studies Confirm the

Importance of Eating Healthy Foods on Healthy Cholesterol Levels.

 

Allium Family Vegetables:

 

Best Sources of Allium Vegetable Compounds: Fresh, raw garlic and onions

contain the highest amounts of these beneficial compounds.

 

Allium family vegetables contain compounds that have been shown to

modestly lower total cholesterol levels, lower blood pressure in cases

of hypertension, and slow the rate of plaque growth.

 

One of these compounds, S-propyl cysteine, has been shown to decrease

the liver cells¡¯ secretion of apolipoprotein B100 (apo B-100). Apo B

100 is virtually the only protein component of LDL, which is composed of

both protein and cholesterol.

 

Apo B-100 is that portion of the LDL molecule that allows it to bind to

receptors on other molecules, such as those that make up the lining of

the blood vessels. Having a high level of apo B-100 in the blood is

therefore a potent risk factor for developing cardiovascular disease.

 

Other S-Alk(en)yl cysteines found in garlic have been shown to inhibit

cholesterol synthesis by lowering the activity of HMG-CoA reductase

30-40%. Garlic incorporated into high fat diets in animal studies has

significantly decreased lipid peroxidation (damage to fats such as

cholesterol) and the activity of a number of enzymes involved in

cholesterol synthesis including HMG CoA reductase.

 

In a randomized, double-blind, placebo-controlled study involving men

with high cholesterol, total cholesterol was lowered 7% and LDL

cholesterol 10% among those given aged garlic extract, and in animals

receiving garlic, blood levels of total cholesterol and triglycerides

dropped by 15 and 30% respectively. In later test tube studies using

cultured rat liver cells, garlic, specifically its water-soluble sulfur

compounds, was found to inhibit cholesterol synthesis 44-87%. Of all

these compounds, S-allylcysteine, was the most potent inhibitor of

cholesterol synthesis. In other test tube studies, evidence has been

presented that shows several garlic compounds can effectively suppress

the oxidation of LDL, and in human subjects, short-term supplementation

of garlic has been shown to increase their LDL's resistance to

oxidation.

 

What foods should I consume sparingly or avoid to promote healthy

cholesterol levels?

Saturated Fat and Cholesterol

Excessive dietary intake of foods rich in saturated fat and cholesterol,

which are found primarily in meat, particularly red meat, and other

animal products, is strongly associated with increased risk of

atherosclerosis and heart disease.

 

Iron

High levels of stored iron are associated with increased free radical

production and therefore increased risk of heart attack, especially in

individuals with high cholesterol levels.

 

Hemochromatosis, a condition of iron overload, is common in Caucasian

males.

 

Iron is a transitional metal that can catalyze the formation of free

radicals called hydroxyl radicals, which can damage cholesterol and have

been linked to cardiovascular disease. Recent studies suggest that the

heme-iron from red meat is more likely to produce hydroxyl radicals than

the heme-iron in chicken, fish or vegetarian sources of protein (e.g.,

beans, nuts and seeds, eggs, and low fat dairy products). Using these

sources of protein as your dietary staples and limiting red meat

consumption is therefore recommended.

 

Trans-Fatty Acids (Hydrogenated Fats)

Trans fats are so-called since their chemical structure is the mirror

opposite of that found in vegetable oils. These abnormally structured

fats can be made from vegetable oils by subjecting them to a chemical

process that transforms them into solid fats. Also called hydrogenated

fats, trans fats increase LDL cholesterol and lipoprotein(a) levels, may

be more damaging to the heart and blood vessels than saturated fat, and

should be eliminated from the diet. These unnatural fats are virtually

absent from whole foods, but are the predominant component in margarine

and are frequently added to processed foods, baked goods, coffee

creamers, and snack foods.

 

Vitamin D

Although necessary for bone strength, excessive amounts of vitamin D are

associated with plaque build-up, especially in those with low magnesium

intake. Increase magnesium intake rather than avoid vitamin D-rich foods

such as salmon, tuna, liver, eggs and milk; these foods provide numerous

important health benefits. Excellent sources of magnesium include Swiss

chard and summer squash. Very good sources include spinach, turnip

greens mustard greens, pumpkin seeds, broccoli, , flax seeds, green

beans, collard greens, kale, sunflower seeds, sesame seeds, quinoa,

buckwheat, salmon, and black beans.

 

Research Studies Confirm the Importance of Eating Healthy Foods on

Healthy Cholesterol Levels

Combining Cholesterol-Lowering Foods as Effective as Statin Drugs

If you have high cholesterol, chances are your physician has suggested a

statin drug to reduce your blood levels of LDL (bad) cholesterol. Statin

drugs work by blocking the enzyme HMG-CoA reductase, which is involved

in the body's production of cholesterol. Although statins are effective

in lowering LDL, they have numerous side effects.

 

Well-known lesser side effects of statin drugs include nausea, diarrhea,

constipation, muscle aches, pains and weakness. In some individuals,

statin use causes an increase in liver enzymes, indicating abnormal

liver functioning. If the increase is only mild, your doctor will likely

tell you to continue taking the drug; if it is too abnormal, you'll be

told to stop, which usually reverses the liver problem.

 

More serious potential side effects include rhabdomyolysis—severe muscle

pain accompanied by the destruction of muscle cells. When this occurs,

the muscle cells release a protein called myoglobin into the

bloodstream. Myoglobin can impair kidney function and lead to kidney

failure.

 

Lesser known side effects include changes in memory, attention, or

concentration, irritability and depression, and a higher risk of suicide

and accidents.

 

Perhaps the most important side-effect of statin drugs, which is likely

a contributor to many of the above noted side effects, is that all

statins deplete the body of CoQ10, a critically important antioxidant

enzyme in our cells' energy production process. Our bodies produce CoQ10

using the same biochemical pathway that creates cholesterol, including

the enzyme HMG-COA reductase, which statin drugs block.

 

Since muscle cells, especially heart muscle cells, and brain cells are

those that use the most energy, adequate supplies of CoQ10 are essential

for health. It's not surprising that statin drugs are accompanied by an

increased risk of muscle pain, wasting and heart failure.

 

Fortunately, a study published in the February 2005 issue of the

American Journal of Clinical Nutrition shows that dietary approaches

combining cholesterol-lowering foods offers another option to statin

drugs.

 

In this study, 34 patients with high cholesterol underwent three 1-month

treatments in random order: a very-low-saturated-fat diet (the control

diet), the same diet plus 20 mg lovastatin daily (statin diet), and a

diet high in plant sterols, which included soy-protein foods (soy milks

and soy burgers), almonds, oats, barley, psyllium, okra and eggplant

(portfolio diets).

 

During each of the three diets, fasting blood samples were taken at

weeks 2 and 4.

 

The results? All 3 diets lowered total cholesterol, which dropped an

average of 8.5 on the control diet, 33.3 on the statin diet, and 29.6 on

the portfolio diet after 4 weeks. However, the portfolio diet lowered

LDL cholesterol as well as the statin diet, and nine study participants

(26%) achieved their lowest LDL cholesterol level while on the portfolio

diet. Given the risks—and expense—associated with statin drugs, if you

have high cholesterol, ask your doctor about a month's trial to see if a

dietary approach combining cholesterol-lowering foods can lower your LDL

cholesterol as well as a statin drug.

 

LDL Cholesterol Lowered by a Whole Foods Diet:

In a landmark study, the effects of consuming a diet high in vegetables,

fruits, soy foods and nuts were compared to either a control diet that

was very low in saturated fat and based on milled whole-wheat cereals

and low-fat dairy foods or the same diet plus the statin drug,

lovastatin. Study participants, a group of 46 adults (25 men and 21

postmenopausal women with high cholesterol whose average age was 59)

were randomly assigned to follow one of these three diets for one month.

At the end of the month, all three groups showed a decrease in LDL (bad)

cholesterol and C-reactive protein (a marker of inflammation that is a

risk factor for cardiovascular disease).

 

In those on the control diet, LDL dropped an average of 8%, and

C-reactive protein dropped an average of 10%.

 

In those on the whole foods diet, LDL dropped an average of 28.6%, and

C-reactive protein dropped an average of 28.2%. In those on the control

diet plus lovastatin, LDL dropped an average of 30.9%, and C-reactive

protein dropped an average of 33.3%.

 

No matter your age, education, smoking status or physical activity, the

more fruits and vegetables you eat, the lower your blood level of LDL

(potentially harmful) cholesterol, suggests research from the National

Heart, Lung, and Blood Institute published in the February 2004 issue of

the American Journal of Clinical Nutrition.

Researchers used data from the Family Heart Study to compare the amount

of fruits and vegetables consumed to LDL levels in 4,466 men and women

ranging in age from 37 to 66. The higher participants¡¯ intake of fruits

and vegetables, the lower their LDL levels. Participants who ate the

most produce (4 or more servings a day) had LDL levels about 7% lower

than those who ate the least (0 to 1.9 servings daily).

 

 

 

Pterostilbene, in Cranberries, Blueberries and Grapes, " Lowers "

Cholesterol

 

Pterostilbene (pronounced TARE-oh-STILL-bean), a powerful antioxidant

compound found in grapes, cranberries and blueberries, which is already

known to fight cancer, may also help lower cholesterol.

 

In a study using rat liver cells, scientists at the USDA Agricultural

Research Service compared the cholesterol-lowering effects of

pterostilbene to those of ciprofibrate, a lipid-lowering drug, and

resveratrol, another antioxidant found in grapes with a chemical

structure similar to pterostilbene that has been shown to help fight

cancer and heart disease.

 

They based their comparison on each compound's ability to activate

PPAR-alpha (short for peroxisome proliferator-activated receptor alpha).

The PPARs are a family of receptors on cells all throughout the body

that are involved in the absorption of compounds into cells for use in

energy production.

 

PPAR-alpha is crucial for the " metabolism " of lipids, including

cholesterol.

 

Pterostilbene was as effective as ciprofibrate and outperformed

resveratrol in activating PPAR-alpha. The take away message: turn up

your cholesterol burning machinery by eating more grapes, blueberries

and cranberries.

 

Beta-glucan in Barley Lowers LDL, Increases HDL Fractions

Adding barley to your healthy way of eating may help you significantly

lower your total and LDL cholesterol, suggests a study published in the

November 2004 issue of the American Journal of Clinical Nutrition.

 

In this study of 25 individuals with high cholesterol (9 postmenopausal

women, 9 premenopausal women, and 7 men), adding barley to the American

Heart Association Step 1 diet resulted in a significant lowering in

total cholesterol in all subjects, plus their amount of large LDL and

large and intermediate HDL fractions (which are considered less

atherogenic) increased, and the smaller LDL and VLDL cholesterol (the

most dangerous fractions) greatly decreased.

 

One reason for these very beneficial effects¡ªa compound found in

barley's fiber called " beta-glucan " .

 

Beta glucan lowers cholesterol by binding to bile acids (which the body

uses to digest fats and makes in the liver from cholesterol) and ferries

it out of the body in the feces. So, the body must make new bile acids,

and to do so, the liver must use up more cholesterol, thus lowering the

amount in circulation.

 

 

 

Unique Antioxidant in Oats Protects LDL Cholesterol

Oats, via their high fiber content, are already known to help remove

cholesterol from the digestive system that would otherwise end up in the

bloodstream. Now, the latest research suggests they may have another

cardio-protective mechanism.

 

Antioxidant compounds unique to oats, called avenanthramides, help

prevent free radicals from damaging LDL cholesterol, thus reducing the

risk of cardiovascular disease, suggests a study conducted at Tufts

University and published in the June 2004 issue of The Journal of

Nutrition.

 

In this study, hamsters were fed saline containing 0.25 grams of

phenol-rich oat bran, after which blood samples were taken at intervals

from 20 to 120 minutes. After 40 minutes, blood concentrations of

avenanthramides had peaked, showing these compounds were bioavailable

(able to be absorbed).

 

Next, the researchers tested the antioxidant ability of avenanthramides

to protect LDL cholesterol against oxidation (free radical damage)

induced by copper.

 

Not only did the avenanthramides increase the amount of time before LDL

became oxidized, but when vitamin C was added, the oat phenols

interacted " synergistically " with the vitamin, extending the time during

which LDL was protected from 137 to 216 minutes.

 

In another study also conducted at Tufts and published in the July 2004

issue of Atherosclerosis, researchers exposed human arterial wall cells

to purified avenenthramides from oats for 24 hours, and found that these

" oat phenols " significantly " suppressed " the " production " of several

types of molecules involved in the " attachment " of monocytes (immune

cells in the bloodstream) to the arterial wall¡

 

ªthe first step in the development of atherosclerosis.

 

Oat avenanthamides suppressed production of ICAM-1 (intracellular

adhesion molecule-1) and VCAM-1 (vascular adhesion molecule-1),

E-selectin, and the secretion of pro-inflammatory cytokines KL-6,

chemokines IL-8 and protein MCP-1 (monocyte chemoattractant protein).

Our advice: Cut an orange in quarters or pour yourself a glass of orange

juice to enjoy along with your oatmeal. If you prefer some other grain

for your breakfast cereal, top it with a heaping spoonful of oat bran.

 

 

 

Whole Brown Rice Lowers LDL Cholesterol

 

Here's yet another reason to rely on whole foods, such as brown rice,

for your healthy way of eating: the oil in whole brown rice, not its

fiber, lowers cholesterol.

 

When Marlene Most and colleagues from Louisiana State University

evaluated the effects of rice bran and rice bran oil on cholesterol

levels in volunteers with moderately elevated cholesterol levels, they

found that rice bran oil, but not rice bran, lowered their LDL (bad)

cholesterol.

 

The study, published in the January 2005 issue of the American Journal

of Clinical Nutrition, was divided into two parts. First, 26 subjects

ate a diet including 13-22g of dietary fiber each day for three weeks,

after which 13 switched to a diet that added defatted rice bran to

double their fiber intake for five weeks.

 

In the second part of the study, a randomized crossover trial, 14

subjects ate a diet with rice bran oil for 10 weeks.

 

While the diet including only defatted rice bran did not lower

cholesterol, the one containing rice bran oil lowered LDL cholesterol by

7%.

 

Since all the diets contained similar fatty acids, the researchers

concluded that the reduction in cholesterol seen in those receiving rice

bran oil must have been due to other constituents such as the

unsaponifiable compounds found in rice bran oil.

 

The scientists suggest that the unsaponifiables present in rice bran oil

could become important functional foods for cardiovascular health. But

why extract just one beneficial compound from brown rice when you can

reap all the cardioprotective benefits supplied by the matrix of

nutrients naturally present in this delicious whole food?

 

In addition to unsaponifiables, this whole grain also supplies hefty

doses of heart-healthy fiber, magnesium, and B vitamins.

 

 

 

Walnuts Lower Cholesterol and A Whole Lot More

A study conducted at the Lipid Clinic in Barcelona, Spain, and published

in the April 2004 issue of Circulation suggests that walnuts protect the

heart by doing much more than just lowering cholesterol.

 

For four weeks, 21 men and women with high cholesterol followed either a

regular, low-calorie Mediterranean diet or one in which walnuts were

substituted for about one-third of the calories supplied by olives,

olive and other monounsaturated fats in the Mediterranean diet.

Then, for a second four weeks, they switched over to the diet they had

not yet been on.

 

Not only did the walnut diet significantly reduce total cholesterol (a

drop that ranged from 4.4 to 7.4%) and LDL (bad) cholesterol (a drop

ranging from 6.4 to 10%),

but walnuts were also found to increase the " elasticity " of the

arteries by 64%, and to reduce levels of " vascular cell adhesion "

molecules, a key player in the development of atherosclerosis (hardening

of the arteries).

 

The researchers found that the drop in cholesterol correlated with

increases in blood levels of alpha-linolenic acid, a key essential fatty

acid from which omega 3 fats can be derived, and gamma-tocopherol, a

form of vitamin E.

 

Walnuts are uniquely rich in both of these nutrients, which have shown

heart protective benefits in other studies. The Food and Drug

Administration has recently cleared the health claim that " eating 1.5

ounces per day of walnuts as part of a diet low in saturated fat and

cholesterol may reduce the risk of heart disease. "

 

" This is the first time a whole food, not its isolated components, has

shown this beneficial effect on vascular health, " said Emilio Ros, who

led the study at the Hospital Clinic of Barcelona.

 

LDL Cholesterol Lowered by a High Fiber Diet:

A study published in the November 2003 issue of the journal Metabolism

also suggests that a diet low in saturated fat but high in fiber,

almonds, soy proteins, and plant sterols (called a portfolio diet by the

researchers) can produce reductions in cholesterol equal to those

reported in recent studies using statin drugs.

In this study of 25 individuals with high cholesterol, for 4 weeks, 13

followed a portfolio diet while 12 ate a low-saturated fat diet based on

whole-wheat cereals and low-fat dairy foods. The groups then switched

diets for a second 4 week period.

 

While the low-fat diet was far less effective than statins, reducing LDL

cholesterol by 12%, the portfolio diet, which reduced LDL cholesterol by

35%, was just as effective as statin drugs. The portfolio diet also

improved the ratio of beneficial HDL-cholesterol to LDL cholesterol by

30%.

 

The researchers concluded that combining a number of foods known to

help reduce levels of LDL cholesterol may be as effective as taking

statin drugs.

 

Fiber's ability to decrease cholesterol is one reason that studies

consistently report that people whose diets contain the most fiber have

a significantly reduced risk of cardiovascular disease.

 

A study published in the September 8, 2003 edition of the Archives of

Internal Medicine suggests that eating " high fiber " foods, such as

beans, flaxseed, apples, bananas, barley, oats and prunes, helps prevent

heart disease.

 

Almost 10,000 American adults participated in this study and were

followed for 19 years, during which time 1,843 cases of coronary heart

disease (CHD) and 3,762 cases of cardiovascular disease (CVD) were

diagnosed.

 

People eating the most fiber, 21 grams per day, had 12% less CHD and 11%

less CVD compared to those eating the least, 5 grams daily. Those eating

the most water-soluble dietary fiber fared even better with a 15%

reduction in risk of CHD and a 10% risk reduction in CVD.

 

LDL Cholesterol Lowered and " Protected " by Monounsaturated Fats:

 

Recent studies have shown that LDL cholesterol particles that contain

monounsaturated fats, such as from olive oil, are much more resistant to

oxidation that those that contain high levels of polyunsaturated fats,

such as from other vegetable oils like corn or safflower oil.

 

In addition, the substitution of monounsaturated fats for saturated fats

in the diet has been shown to decrease total cholesterol by 13.4% and to

decrease LDL cholesterol by 18%.

 

 

Studies in weight-stable persons have shown that a diet including a

moderate amount of fat results in lower blood levels of triglycerides

and higher levels of beneficial HDL cholesterol than a low-fat diet.

 

Now a new study suggests that a weight-loss diet high in

monounsaturated fat and moderate in total fat may be more heart-healthy

than one that¡¯s low in fat.

 

In this new study, published in the February 2004 issue of the American

Journal of Clinical Nutrition and funded by the Peanut Institute, 53

overweight and obese men and women were randomly assigned to follow

weight-loss diets for that were either very low in fat (18% of calories

from fat) or moderate in fat (33% fat, with half the fat from peanut

products).

 

Participants consumed the weight-loss diet for six weeks, after which

they followed a weight maintenance diet for an additional four weeks.

 

After the six week weight-loss period, both groups had lost about 15

pounds and lowered their levels of potentially harmful LDL. However,

while those on the moderate fat diet kept their protective HDL

cholesterol at the same level, thus significantly improving their ratio

of HDL:LDL, those on the low-fat diet saw their HDL cholesterol drop by

12%, so their ratio of HDL:LDL did not improve ¡ªoffsetting some of the

heart benefits.

 

In addition, during four weeks of weight maintenance, HDLs remained

high in the moderate-fat group, who also further lowered their

triglyceride levels, while triglyceride levels rebounded in those on the

low-fat diet. (High triglycerides are a problem because they promote fat

" absorption " in the artery wall.)

 

The message: moderate consumption of healthy monounsaturated fats, such

as are found in olive oil and nuts, e.g., peanuts, appears to lessen

risk of cardiovascular disease more than a low-fat diet.

 

We'd add that the moderate fat diet is easier to follow since a little

healthy fat adds satiety and a lot of flavor to your meals.

 

LDL Cholesterol Lowered by Allium Family Vegetables:

 

Compounds found in garlic called S-Alk(en)yl cysteines have been shown

to inhibit cholesterol synthesis by lowering the activity of HMG-CoA

reductase, the key enzyme involved in cholesterol production, by 30-40%.

 

 

Garlic incorporated into high fat diets in animal studies has

significantly decreased lipid peroxidation (damage to fats such as

cholesterol) and the activity of a number of enzymes involved in

cholesterol synthesis including HMG CoA reductase.

 

In a randomized, double-blind, placebo-controlled study involving men

with high cholesterol, total cholesterol was lowered 7% and LDL

cholesterol 10% among those given aged garlic extract, and in animals

receiving garlic, blood levels of total cholesterol and triglycerides

dropped by 15 and 30% respectively.

 

In later test tube studies using cultured rat liver cells, garlic,

specifically its water-soluble sulfur compounds, was found to inhibit

cholesterol synthesis 44-87%.

 

Of all these compounds, S-allylcysteine, was the most potent inhibitor

of cholesterol synthesis.

 

In other test tube studies, evidence has been presented that shows

several garlic compounds can effectively " suppress " the " oxidation " of

LDL, and in human subjects, short-term supplementation of garlic has

been shown to increase their LDL¡¯s resistance to oxidation.

 

LDL Cholesterol Protected by Vitamin E:

 

Studies have shown that people with lower vitamin E levels tend to have

a higher rate of ischemic heart disease mortality and vice versa. One

study found that people with the highest intake of vitamin E from

dietary sources had less than half the risk of cardiac events when

compared to those with the lowest intake.

 

Other studies have shown that the use of vitamin E supplements has

produced a 50% reduction in the progression of atheroma growth, a 63%

decrease in coronary heart disease death, a 34% reduction in risk of

cardiac events in women, a 77% decrease in the reoccurrence of non-fatal

myocardial infarction, and a 39% decrease in risk of heart disease in

men.

 

Overall, the use of vitamin E supplements at any time was associated

with a 47% decrease in heart disease related mortality.

 

LDL Cholesterol Protected by Beta-Carotene:

 

Although beta-carotene is not found in high quantities in LDL

cholesterol particles, it has been shown to prevent the oxidation of LDL

cholesterol. Beta-carotene, like vitamin C, is also able to increase

vessel dilation and reduce vessel spasm.

 

One study has shown that patients with the " lowest " level of

" beta-carotene " intake had almost twice the risk of having a heart

attack compared to those with the highest intake.

 

The group of patients taking the highest intake of beta-carotene had

about 1/3 the risk of fatal heart attack and about 1/2 the risk of

cardiovascular death as those in the group with the lowest intake.

 

HDL Cholesterol Increased by Cranberries:

A human study has recently shown that drinking cranberry juice can cause

a significant increase in HDL cholesterol levels.

 

In this three month study, researchers measured cholesterol levels in 19

subjects with high cholesterol after a fasting, baseline blood sampling,

followed by monthly samplings.

Ten of the subjects were given cranberry juice with artificial

sweetener, while the other subjects drank cranberry juice with no added

sugars.

 

Like typical supermarket cranberry juices, the drinks all contained

approximately 27% pure cranberry juice by volume. Each subject drank one

8-ounce glass of juice a day for the first month, then two glasses a day

for the next month, and finally, three glasses a day during the third

month of the study. Subjects were not monitored with respect to

exercise, diet and alcohol consumption.

 

Although no changes occurred in their overall cholesterol levels, study

subjects' HDL cholesterol increased by an average of 10% after drinking

three glasses of cranberry juice per day.

 

While the mechanism by which cranberry juice changes cholesterol levels

has not been clearly established, the researchers have theorized that

the effect is due to the fruit's high levels of " polyphenols " , a type of

potent " antioxidant " .

 

 

 

Compounds in Oranges and Tangerines May Lower Cholesterol Better than

Statin Drugs

 

A class of compounds found in citrus fruit peels called

" polymethoxylated flavones " (PMFs) have the potential to lower

cholesterol more effectively than some prescription drugs, and without

side effects, according to a study by U.S. and Canadian researchers that

was published in the May 2004 issue of the Journal of Agricultural and

Food Chemistry.

 

In this study, when hamsters with diet-induced high cholesterol were

given the same diet containing 1% PMFs (mainly tangeretin), their blood

levels of total cholesterol, VLDL and LDL (bad cholesterol) were reduced

by 19-27 and 32-40% respectively.

 

Comparable reductions were also seen when the hamsters were given diets

containing a 3% mixture of two other citrus flavonones, hesperidin and

naringin.

 

Treatment with PMFs did not appear to have any effect on levels of

beneficial HDL cholesterol, and no negative side effects were seen in

the animals fed the PMF-containing diets.

 

Although a variety of citrus fruits contain PMFs, the most common PMFs,

tangeretin and nobiletin, are found in the peels of tangerines and

oranges.

 

Juices of these fruits also contain PMFs, but in much smaller amounts.

In fact, you'd have to drink about 20 glasses of juice each day to

receive an amount of PMFs comparable in humans to that given to the

hamsters.

 

However, grating a tablespoon or so of the peel from a well-scrubbed

organic tangerine or orange each day and using it to flavor tea, salads,

salad dressings, yogurt, soups, or hot oatmeal, buckwheat or rice may be

a practical way of achieving some cholesterol-lowering benefits.

 

The researchers are currently exploring the mechanism of action by which

PMFs lower cholesterol. Based on early results in cell and animal

studies, they suspect that PMFs work like statin drugs, by inhibiting

the synthesis of cholesterol and triglycerides inside the liver.

 

 

 

Organic Soy Offers Special Cholesterol-Lowering Benefits for

Premenopausal Women

 

Soy foods may offer special benefits for the hearts and bones of

premenopausal women, suggest two studies conducted at Wake Forest

University Baptist Medical Center and presented at the annual meeting of

the North American Menopause Society, Washington, D.C., October 6-9,

2004.

 

The results of these studies indicate a beneficial synergy between

" isoflavones " , the weakly " estrogenic " compounds in soy, and the body's

own estrogen in " decreasing " cholesterol and " increasing " bone mass.

 

In the first study, cholesterol levels in monkeys fed a soy-based diet

were improved compared to those of monkeys given a diet of milk and

animal protein¡ªand the most improvement occurred in those monkeys at

highest risk for heart vessel disease.

 

A low ratio of total cholesterol to HDL (good) cholesterol is

considered healthier. In monkeys at highest risk for heart disease, the

cholesterol ratio decreased by 48% in those given soy compared to those

receiving milk and animal protein. Even in the monkeys at low risk for

atherosclerosis that ate soy, the cholesterol ratio dropped 33%.

 

Lead researcher in this study, Jay Kaplan, PhD, noted that a 48%

" drop " in the cholesterol ratio would likely equate to a 50% " reduction "

in the " size " of 'plaques'in the arteries, which can rupture causing

heart attacks and strokes.

 

He also added, " Studies have shown that heart vessel disease, or

atherosclerosis, begins in the 30s and 40s in women.

 

From our work in monkeys, we believe the time to prevent cardiovascular

disease in women is before menopause, not after. Soy seems to provide a

potent protection in monkeys, in terms of cholesterol levels, which is a

good marker for general cardiovascular risk. We presume the benefit

would apply to premenopausal women as well. "

 

In the second study, monkeys eating soy were found to have an increase

in bone mass compared to those not given soy. According to lead

researcher in this study, Cynthia Lees, D.V.M., Ph.D.,

 

" The increase was small, but this suggests the possibility that if women

consumed soy on a regular basis before menopause, it could benefit their

health after menopause. "

 

Kaplan also noted that because the soy-estrogen combination caused

improvements in both cholesterol and bone, it might also positively

" impact " other areas of the body affected by estrogen, including the

brain.

 

In both 12 month long studies, the monkeys were selected to represent

women in their 30s and 40s. Half consumed soy with isoflavone levels

equal to a human intake of approximately 129 milligrams a day, about

twice the amount typically consumed by women in Asia.

 

Next on the researchers' agenda will be a study using lower levels of

isoflavones over a longer period of time to see if this will be as

effective¡ªan outcome that appears to already be supported in a human

trial published in the November 2004 issue of the American Journal of

Clinical Nutrition.

 

In this study, which included 1033 pre- and postmenopausal women (361

meat-eaters, 570 vegetarians, and 102 vegans), eating moderate amounts

of soy foods as part of a regular diet was associated with a lower ratio

of total to LDL cholesterol, but not with a lowering in the level of

beneficial HDL cholesterol. In those women eating 6 or more grams of soy

protein daily, blood levels of LDL cholesterol were 12.4% lower than

those in women who ate less than .5 grams of soy protein daily.

 

What is cholesterol, and why should I be concerned if my cholesterol

levels are too high?

 

Cholesterol is a necessary substance that is produced by the body from

fatty acids, especially saturated fats, in the diet. Ready-made

cholesterol is also absorbed from foods derived from animals.

 

From the bloodstream, cholesterol is taken up by cells and used to

" make " cell membranes, hormones and vitamin D.

 

Cholesterol is produced in the liver by a number of steps involving

several different enzymes. One of the main enzymes involved is called

HMG Co-A reductase. This enzyme has the single most control over how

much cholesterol is produced.

 

HMG Co-A reductase usually " ensures " that just enough cholesterol is

" produced " for " normal " function, but sometimes, especially when the

diet is high in saturated fats, it shifts into " overdrive " and

contributes to elevated cholesterol levels.

 

If the diet is also high in cholesterol-containing animal foods, then

cholesterol levels may rise even more.

 

Once produced, cholesterol is carried in the blood by lipoproteins such

as very-low-density lipoprotein (VLDL), low-density lipoprotein (LDL),

lipoprotein (a), and high-density lipoprotein (HDL). VLDL and LDL

distribute cholesterol throughout the body to where it is needed.

 

HDL collects any " extra " cholesterol not needed by cells and " returns "

it to the liver, thus " removing " it from the bloodstream where it has

the " potential " to cause damage to blood vessels.

 

For this reason, HDL is often referred to as the ¡°good¡± cholesterol.

 

The most potentially damaging form of cholesterol is lipoprotein (a).

Lipoprotein (a) is a " cholesterol-carrying " molecule like LDL that also

contains a " sticky " molecule, " apolipoprotein " , which enables it to

" adhere " more easily to the " lining " of the blood vessel walls and

contribute to atherosclerosis.

 

Normally, cholesterol in the body that is not used to produce hormones,

vitamin D, or cell membranes is " eliminated " by the liver.

 

The liver " converts " the " cholesterol " to " bile " , which is stored in the

gall bladder until it is needed in the intestines.

 

When bile is released into the intestines, it aids digestion by making

dietary fats easier to " absorb " .

 

Much of the bile that passes into the intestines is reabsorbed and

recycled for future use.

 

However, if it " binds " to certain food substances, like fiber, it

" passes out " of the body in the stools, so new bile must be produced

from cholesterol to replace the bile that is eliminated.

 

This is one of the reasons why fiber-rich foods such as legumes and

whole grains can help lower cholesterol.

 

When cholesterol in food becomes oxidized, either by heat or free

radicals, before it is consumed and absorbed in the intestines, or if

cholesterol from food or cholesterol produced by the liver is " oxidized "

by " free radicals " in the body, it can become dangerous.

 

Oxidized LDL cholesterol is directly " toxic " to the " endothelial cells "

that line blood vessel walls.

 

It increases the adhesion of immune cells called monocytes and

macrophages to vascular lesions (damaged areas in the blood vessel

wall), increases the proliferation of smooth muscle cells in the blood

vessel wall, increases platelet clumping and clot formation, and

inhibits the production of nitric oxide, a messenger chemical that tells

blood vessels to relax and dilate.

 

When macrophages and monocytes are exposed to undamaged cholesterol,

they only take in small amounts, but when they are exposed to " oxidized "

(damaged) cholesterol, they take in large amounts, causing them to

greatly increase in size.

 

A high blood level of oxidized LDL cholesterol is therefore a strong

" contributing factor " in the initiation and growth of atheromas

(cholesterol-filled plaques in the walls of the arteries) and the

progression of heart disease.

 

Atheromas are especially problematic when they " develop " in the blood

vessels of the heart, also known as the coronary arteries, where they

may " decrease " the " amount " of blood that is " available " to feed the

heart muscle, or where they may eventually lead to a heart attack, (in

medical terminology, a myocardial infarction or MI), heart damage, and

possibly even death.

 

By contributing to the " formation " of " atheromas " , high cholesterol can

lead to atherosclerosis, heart disease, heart attack and stroke.

 

Over half of all cases of coronary heart disease in the United States

are attributed to " abnormalities " in the levels and metabolism of

cholesterol and other lipoproteins.

 

On the bright side, even a small decrease in cholesterol correlates with

a modest decrease in the risk of heart disease.

 

What causes high cholesterol?

 

The primary causes of high cholesterol include diet, obesity, a

sedentary lifestyle, heredity, and stress. Obesity and cigarette smoking

are correlated with decreases in the protective HDL fraction of

cholesterol.

 

Secondary causes of high cholesterol include hypothyroidism, diabetes

mellitus, nephrotic syndrome, and obstructive liver disease.

 

Drugs known to cause high cholesterol as a side-effect include anabolic

steroids, progestins, most diuretics, and some beta blockers.

 

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