Lots of controversy and confusion surround cholesterol. In patients who have coronary artery disease, peripheral artery disease or carotid artery disease, there is no question about the benefit of cholesterol-lowering medications. However, for the rest of us who don't have these diseases and don't want to get them, how can we lower our cholesterol naturally?
There are a couple proven ways to lower cholesterol naturally:
1. First, you have to modify your eating habits. Replace unhealthy fats (trans and saturated) with healthy fats (monounsaturated and polyunsaturated). This means becoming a food label reader. Trans fat should not be part of your diet. These kinds of fats lower good cholesterol (HDL) and raise your bad ones (LDL). They are found in margarine, shortenings, fried foods and so on. Any product that contains partially hydrogenated oil has trans fat. In addition to avoiding trans fat, limit your saturated fat intake. There should be no more than 2 grams of fat per serving, and it should account for less than 7 percent of your daily calorie intake. Saturated fats are most often found in animal products (such as beef, pork, chicken skin, hot dogs and regular cheese) and tropical oil (think palm and coconut oil).
2. You have to increase your consumption of dietary fiber. Ideally, you should be getting 25 to 35 g of fiber a day. Fiber binds to cholesterol and eliminates it from your body. You can increase your fiber by getting more whole grains, legumes (such as beans and lentils), vegetables and fruits. There are two types of fiber: Soluble fibers are more beneficial for cholesterol, while insoluble fibers are better for your gut health. You should get good mix of both.
3. A word on flax, which is soluble fiber: The benefit of flax has been known since Hippocrates' time. In the middle ages, King Charlemagne made flax a mandatory diet requirement for all his subjects. It can lower triglyceride levels, and flax also contains a plant omega-3 fatty acid called alpha-linolenic acid. Flax is a risk source of high-quality protein and potassium and contains lignans, which are phytoestrogen and antioxidants. Eat your flax -- don't take it in pill or oil form, since such versions lack fiber, lignans and protein. When you eat flaxseed, make sure you grind the seeds to get the most benefit. Also, put flax in the refrigerator as soon as you grind it. The whole flax can be stored at room temperature for one year, but once it's grounded, it goes bad -- so grind a little bit at a time. Aim for 2 to 3 tablespoons of ground flaxseed a day. Try putting it in your food, such as cereal, yogurt and salad.
4. Say you've incorporated dietary changes, and your cholesterol is still high. What else can you do naturally? You can incorporate phytosterol into your diet. These are plant sterol and stanol esters found in plants that are similar to the body's cholesterol and can compete with cholesterol for absorption in the digestive system. Phytosterol can lower your cholesterol by 10 percent and your LDL (bad cholesterol) by 14 percent. Aim to get about 2 grams of phytosterol a day. Some common food and dietary supplements include high sterol or stanol esters -- read the labels.
5. A word on fish: Oily fishes are best, which means salmon, tuna, sardine, mackerel and herrings. Ideally, you should get two servings per week, and you can supplement with fish oil. Very high doses of pure fish oil can lower your triglyceride levels (another type of fat in your blood) and increase your good cholesterol, but it really doesn't lower your LDL. You have to read your fish oil supplement label. Check out the EPA plus DHA in each serving of fish oil -- those are the effective ingredients. If your fish oil says 1,000 mg of fish oil but only contains 300 mg of EPA and DHA, know that you're taking 700 mg of unnecessary fish blubber. So choose fish oil with the highest amount of EPA plus DHA in each pill.
6. Finally, let's talk about "vitamins" to lower your cholesterol. The only one that really lowers cholesterol is red yeast rice at 1,200 mg twice a day. The problem with red yeast rice is that it contains the same chemical compound as lovastatin, which means you need to have your liver function monitored. There have been several Food and Drug Administration warning letters about red yeast rice due to its liver toxicity. Talk to your doctor before starting it. Also: Garlic, grape seed and vitamins C, E, D do not lower cholesterol.
Yes, you can lower your cholesterol naturally, and diet should be the cornerstone of therapy. Pills are a supplement, and not a substitute for a good diet.
Leslie Cho, MD, is Director of the Cleveland Clinic's Women's Cardiovascular Center. She is also Section Head, Preventive Cardiology and Rehabilitation in the Robert and Suzanne Tomsich Department of Cardiovascular Medicine at Cleveland Clinic. Dr. Cho is board-certified in interventional cardiology, cardiovascular medicine and internal medicine. Her specialty interests focus on general cardiology, heart disease and peripheral arterial and vascular disease, and their attendant therapies and treatments. Dr. Cho's clinical research interests are women and heart disease and the role of nutrition in hypercholesterolemia. Her research has garnered her many grants to study various therapeutic treatments for heart disease. In 1998, she received the American Heart Association's Women in Cardiology award. In 1999, the World Heart Federation named her Fellow of Cardiovascular Epidemiology and Prevention. She is author or co-author of numerous peer-reviewed articles and abstracts in leading medical journals, and she has authored medical textbooks and contributed chapters to medical textbooks related to her specialty interests. Dr. Cho is a fellow of the American College of Cardiology and serves on the Peripheral Disease Committee. She is a member of the American Board of Internal Medicine and the American Heart Association.