Lowering Cholesterol with a Healthier Way of Eating

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Lowering Cholesterol with a Healthier Way of Eating

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, 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: 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 Saut;é 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.

 

 

 

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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