information on nutrients, diet, lifestyle & research on treatment
Elevated Serum Cholesterol
High blood cholesterol has historically been connected to a high risk of heart disease but current research suggests that people with high cholesterol are no more likely to experience a heart attack than those without.
- Exercise: Getting even mild exercise has been found to increase protective HDL cholesterol.
- Weight loss: Obesity increases risk, partially because weight gain reduces protective HDL cholesterol levels.
- Quit smoking: Smoking is tied to low HDL levels and is also known to cause heart disease.
- Stress reduction: Stress and type A behavior is a risk factor.
- Indicators: High levels of c-reactive protein and homocysteine are considered to be better risk indicators than high cholesterol.
Note that some people do not experience significant drops in cholesterol with even large changes in their diet.
- Number and size of meals Avoid very large meals and eat more frequent but smaller meals.
- Eat soy: Isoflavones from soybeans reduce both total and LDL cholesterol.
- Low-fat foods: "Low-fat" milk products are not really very low in fat. Issue of homogenization.
- Eat fatty fish which is tied to a lower risk of heart disease in most studies and which contain helpful EPA and DHA, omega-3 fatty acids.
- Eat vegetables: Vegetarians have been found to have less heart disease and lower cholesterol than meat eaters, partly because their diet does not include animal fat.
- Use olive oil which is high in monounsaturated fatty acids to replace saturated fat
- Fiber has been found to reducecholesterol levels. Good sources are glucomannan and flaxseed
- Moderate Alcohol drinking (1-2 drinks daily) reportedly increases the protecting HDL form of cholesterol but for other reasons, may increase risk.
- Eating garlic behaves like a blood thinner and may reduce other risk factors as well.
- Green tea: About three cups per day can help lower cholesterol.
- Eat nuts: Research consistently shows that people who frequently eat nuts have a dramatically reduced risk of heart disease. Treating nuts for better effect.
- Drink chicory instead of coffee which reduces cholesterol levels and increases the ratio of HDL to LDL
- Don't gorge: Nibble - eat slowly
- Avoid sugar: Eating sugar has been reported to worsen risk factors linked to heart disease.
- Dietary Fats: Reduce saturated fats from animals that increase risk.
- Avoid trans fatty acids
- Reduce egg consumption: When cholesterol from eggs is cooked or exposed to air, it oxidizes and is tied to heart disease risk. 29, 31-24
- Avoid coffee: Less doffee and have chicory sometimes instead.
Nonetheless, high cholesterol is an indicator of imbalance and should be addressed. Most medical professionals recommend that levels of cholesterol should remain below 200. As levels decrease below 200, risk declines. Many medical providers consider cholesterol levels of no more than 180 to be best.
Diet, lifestyle consideration, exercise and taking specific supplements can all play a major role in managing high cholesterol.
LDL & HDL
Total cholesterol measurements are divided into several types: LDL cholesterol, directly linked to heart disease, and HDL cholesterol, the so-called "good" cholesterol. The proportion of HDL to LDL is more critical than total cholesterol alone. Someone who has high HDL can have a low risk for heart disease even with total cholesterol that is greater than 200. Other high risk factors of heart disease include: high levels of triglycerides, homocysteine levels and high c-reactive protein levels. Consult with your medical professional to assess changes in cholesterol.
High cholesterol rarely causes symptoms. It is usually detected during a routine blood test that measures cholesterol levels. You may first discover it when you are diagnosed with a condition that is caused in part by high cholesterol such as coronary artery disease, stroke or peripheral vascular disease.
Some people with lipid disorders such as familial hypercholesterolemia may have other distinct symptoms such as deposits of excess cholesterol that collect in the skin or eye tissue. These cholesterol deposits can also cause nodules in tendons in the hands or feet or, rarely, yellow streaks in the hands.
Causes of high cholesterol vary depending on the lifestyle, gender or the heritage of the individual.
- Weight Americans weigh more now than all of the past ten years combined. With busy careers and children's heavy extra-curricular activities, our tendency is to grab something quick while rushing out the door. While this is convenient and makes life easier for the moment, the long-term effects of a poor diet can be devastating.
- Diet Foods made from saturated fats are a contributing factor to high cholesterol.
- Exercise Lack of exercise in a sedentary lifestyle is another contributing factor.
- Age and Gender Cholesterol levels begin increasing for both men and women as age goes up. Women generally have a lower level than men do between the age of 50 and 55. However, once a woman starts into menopause, the natural occurrence is that the cholesterol level starts to increase.
Family genes play a big role in the amount of cholesterol you might have to deal with. If you have a parent that has had to battle with high levels of cholesterol, your chances of following in their footsteps is high.
If your physician has determined that you have a high level of cholesterol, do some research to determine if other members of your family have this problem. Ask what medications or therapies they have had success with. More than likely, that same method will help you.
Each one of us can do certain things to live healthier, longer lives. One of those choices includes maintaining cholesterol at the right level. However, the truth is even young, thin, physically fit people can have high levels of cholesterol, although chances of higher levels increase due to certain factors. Lifestyle management can change some of these factors while others require a more aggressive approach to include cholesterol lowering medication.
People with high cholesterol are commonly advised to reduce their consumption of dietary cholesterol and saturated fats. In addition, cholesterol-lowering medications, such as bile acid sequestrants and HMG-CoA Reductase Inhibitors are often prescribed. For women who have gone through menopause, conventional treatment may also include hormone replacement therapy.
- Exercise: Getting regular exercise has been found to increase protective HDL cholesterol, even if only walking and resulting in a relatively low risk of heart disease. Those patients over 40 or those who have been diagnosed with heart disease should talk to their medical provider before starting an exercise program; too much too fast can trigger heart attacks.133, 134
- Weight loss: Obesity increases risk, partially because weight gain reduces protective HDL cholesterol levels. In addition weight loss reduces the body's ability to make cholesterol, increases HDL, and reduces triglycerides. 137-140
- Quit smoking: Smoking is tied to low HDL levels and is also known to cause heart disease. Quitting smoking reduces heart attack risk.142-144
- Stress reduction: Feelings of hostility, time urgency and stress (often referred to as a type A behavior) is a risk factor. Type A men are at higher risk for heart disease in most studies. Stress or type A personalities may elevate cholesterol levels. Reducing stress and feelings of hostility reduces the risk.. 145-151
- Medical researches now consider high levels of c-reactive protein and homocysteine to be a better indication of heart disease risk.
Note that some people do not experience significant drops in cholesterol with even large changes in their diet.
- Number and size of meals When people eat more small meals, serum cholesterol levels fall compared with the effect of eating the same food in three big meals. People with elevated cholesterol levels should probably avoid very large meals and eat more frequent but smaller meals.131-132
- Eat soy: (30 grams per day of soy protein) Tofu, tempeh, miso, and some protein powders in health food stores are derived from soybeans. Isoflavones from soybeans reduce both total and LDL cholesterol.62-71
- Low-fat foods: Skimmed milk, non-fat cheese and non-fat yogurt are pretty much fat-free. But the "low-fat" milk products are not really very low in fat. 25% of the calories from 2% milk comes from fat (the volume of fat, not the % of calories). Furthermore and controversially, a few researchers suspect that homogenized milk may be a culprit. It contains broken-apart particles of indigestible xanthine oxidase thought to destroy plasmalogen, a protective membrane fat permitting damage to the lining of blood vessels which are then more susceptible to accumulating plaque.316, 317 But fat may be the bigger issue.
- Eat fish which increases HDL cholesterol, has little saturated fat and is tied to a lower risk of heart disease in most studies. Fatty fish such as salmon, mackerel and many small fish like herring contain EPA and DHA, omega-3 fatty acids that have been suggested in research studies to reduce heart disease risk.20-22
- Eat vegetables: Vegetarians have been found to have less heart disease and lower cholesterol than meat eaters, partly because their diet does not include animal fat. Vegans have the lowest cholesterol levels, and going on such a diet has reversed heart disease in some studies. Dr. Dean Ornish's books are the classic guides to balanced vegetarian and vegan diets.24-28
- Use olive oil which is high in monounsaturated fatty acids. Use it to replace saturated fat which can result in lowering LDL cholesterol. People from countries that use olive oil rather than saturated fats have been studied as showing a lower risk for heart disease. Although olive oil is safer for those with high cholesterol, it is still very high in calories, and so should be limited in overweight people.88-92
- Fiber (20 grams per day for several months). In most studies, soluble fiber from oats, beans, psyllium seed and fruit pectin has reduced cholesterol levels. Medical professionals often recommend that those with high cholesterol eat more of these foods. However, even insoluble grain fiber which does not lower cholesterol has been linked to lower risk of high cholesterol.35-41
- Glucomannan is a water-soluble edible fiber that comes from konjac root. Double blind research has demonstrated that glucomannan supplementation markedly reduces total blood cholesterol, LDL cholesterol and triglycerides, and in some cases raises HDL cholesterol. Effective amounts of glucomannan for lowering blood cholesterol have been 4-13gm daily.152-155
- Flaxseed is another good source of soluble fiber and has been reported to lower cholesterol. The cholesterol-lowering component in flaxseed is likely to be the fiber and not the oil. Thus, it makes sense to use partially defatted flaxseed instead of whole flaxseed or flaxseed oil to lower cholesterol.56
- Moderate Alcohol drinking (1-2 drinks daily) reportedly increases the protecting HDL form of cholesterol. It apparently occurs equally with different sorts of alcohol-containing drinks, although researchers favor red wine due to the flavonoids and other antioxidants it contains. Alcohol behaves like a blood thinner, and may also lower heart disease risk. However, alcohol raises the levels of triglycerides in the blood and consumption can cause liver disease, cancer, high blood pressure, alcoholism, and at high intake, an increased risk of heart disease. In deciding whether light drinking might do more good than harm, people with high cholesterol should consult a medical professional. 82-85
- Eating garlic has been reported in some (but not all) related research studies. Garlic behaves like a blood thinner and may reduce other risk factors as well. Medical providers typically suggest eating garlic as food, taking 900mg garlic powder (capsules providing 5,000-6,000mcg of allicin), or using a tincture of 2-4ml 3 times a day. Individuals taking warfarin should consult a healthcare practitioner before taking garlic supplements. Enteric coated garlic tablets appear more promising.285-296
- Green tea (Camellia sinensis) intake, about three cups per day (providing 240-320 mg of polyphenols), can help lower cholesterol.297-301
- Eat nuts: Research consistently shows that people who
frequently eat nuts have a dramatically reduced risk of heart disease, probably because nut consumption
lowers cholesterol levels. Of nuts commonly consumed, almonds and walnuts may be the most effective at
lowering cholesterol and macadamia nuts may be least beneficial. Hazelnuts and pistachio nuts may also
help lower cholesterol.111-140 Roasted nuts rather than raw nuts is recommended as roasting
reduces the risk of the oils in the nuts going rancid.
According to Ayurvedic medicine another good treatment of nuts to enhance their healthy benefit is to soak them overnight in water, and then dry them at low temperature (ie 115°) for a few hours. This makes them lighter and more digestible .
- Drink chicory instead of coffee which reduces cholesterol levels and increases the ratio of HDL to LDL in animal tests.319
- Avoid large meals: Additionally, don't gorge. Nibble rather than gobbling it down - eat slowly131-132
- Avoid sugar: Eating sugar has been reported to reduce protective HDL cholesterol and slightly increase (worsen) other risk factors linked to heart disease. 72-74
- Dietary Fats: Reduce saturated fats that increase risk from animals. Significant quantities of saturated fat are found in veal, pork, beef, poultry (especially poultry skins and dark meat), palm oil, coconut oil, butter, cheese, ice cream, and other forms of dairy products that are not labeled fat-free. 1-8
- Avoid trans fatty acids: TFAs are an ingredient in many processed foods made with hydrogenated oils. Margarine has the highest levels of TFAs and consumption increases the ratio of LDL to HDL. Margarine and other processed foods containing partially hydrogenated oils should be avoided. 93-94
- Reduce egg consumption: Although eating eggs may not increase cholesterol if the overall diet is low in fat, it increased serum cholesterol in most studies. Moreover, when cholesterol from eggs is cooked or exposed to air, it oxidizes. Oxidized cholesterol is linked to increased risk of heart disease. 29, 31-24
- Avoid coffee: Drinking boiled or French press coffee increases cholesterol levels although drinking paper filtered coffee generally does not increase cholesterol levels. However, paper-filtered coffee does appear to significantly increase homocysteine - another risk factor for heart disease. The effects of decaffeinated coffee on cholesterol levels remain in debate. As for expresso, it depends on the method, but there needs to be research.75-83
Key nutritional supplements
- Vitamin B3 High amounts (several grams per day) of niacin, a form of vitamin B3, lower cholesterol. The other common form of B3 niacinamide does not. Some cardiologists recommend 3gm of niacin daily for those with high cholesterol levels. At such high levels acute flushing, stomachaches and headaches may occur. Liver damage, gastritis, diabetes, eye damage and possibly gout toxicity may also result. Therefore these high levels might bring discomfort or danger to one's health. High intakes of niacin must only be taken under the supervision of a your qualified medical professional.180-187
- Pantethine (300 mg taken two to four times per day): Pantethine, a special form of vitamin B5 (pantothenic acid), has been shown to significantly lower serum cholesterol levels and increase HDL. Common pantothenic acid has not been reported to have this effect.161-168
- Vitamin C (100 mg to 1 gram per day): Vitamin C protects LDL cholesterol from oxidative damage and may help lower elevated LDL cholesterol. Most protection against heart disease from vitamin C is likely to occur with as little as 100 mg per day. 157-160
- Beta-glucan is a soluble fiber molecule the comes from cell walls of oats, baker's yeast, barley and medicinal mushrooms such as maitake mushrooms. Beta-glucan is the key factor for the cholesterol-lowering effect of oat bran. For lowering cholesterol levels, the amount of beta-glucan used has ranged from 2,900 to 15,000 mg per day. Researchers have found that its beneficial effects appear to be negated in cooked foods.318
- Beta-hydroxy-beta-methylbutyrate (HMB): The combined results of a number of double-blind trials demonstrate that supplementation with beta-hydroxy-beta-methylbutyrate (HMB) lowers total and LDL cholesterol. All nine trials used 3gm daily, for 3-8 weeks.156
- Chromium/brewer's yeast (200 mcg daily; true brewer's yeast contains up to 60mcg of chromium/tablespoon, and a reasonable intake is 2 tablespoons daily). Chromium supplementation has been found to reduce LDL cholesterol and increase HDL cholesterol in human studies. Brewer's yeast, which contains readily absorbable chromium, has also lowered serum cholesterol. To use brewer's yeast as a chromium source look for products specifically labeled "from the brewing process" or "brewer's yeast," because most yeast found in health food stores is not brewer's yeast and does not contain chromium.169-179
Other nutritional supplements that may be helpful
- Flaxseed: (raw, defatted) 15 grams per day.
- Inositol hexaniacinate (500-1,000 mg three times per day instead of niacin): People should not take niacin, including inositol hexaniacinate, without the supervision of a healthcare provider.
- Royal jelly: Royal jelly has prevented the cholesterol-elevating effect of nicotine and has lowered serum cholesterol in animal studies. Preliminary human trials have also found that royal jelly may lower cholesterol levels. An analysis of cholesterol-lowering trials shows that 50 to 100 mg per day is the typical amount used in such research.
- Tocotrienols: 200 mg per day.
- Fenugreek (Trigonella foenum-graecum) powder: 10-30 grams three times per day with meals.
- Guggul (Commiphora mukul) (providing 25 mg of guggulsterones three times per day for at least 12 weeks): Guggul is a mixture of substances taken from the plant Commiphora mukul. Guggul extract has been shown to lower total cholesterol and raise HDL cholesterol. Daily intakes of guggul are based on the amount of guggulsterones in the extract. Most extracts contain 5-10% guggulsterones.
- Psyllium (Plantago ovata, Plantago ispaghula) (5-10 grams added to the diet per day to lower cholesterol levels): Use of psyllium has been extensively studied as a way to reduce cholesterol levels.An analysis of all double-blind studies concluded that psyllium lowered cholesterol levels by 5% and LDL cholesterol by 9%.
- Red yeast rice (Monascus purpureus) (1.2-2.4 grams [5-10 mg monacolins] per day in divided amounts for at least 12 weeks): A proprietary red yeast product (Cholestin®) contains ten different compounds called monacolins that inhibit cholesterol synthesis. One of these compounds is lovastatin (Mevacor®), a prescription drug used to reduce cholesterol levels. Although lovastatin occurs naturally in red yeast rice, the sale of Cholestin has been banned in the United States, as a result of a lawsuit alleging patent infringement. Other red yeast rice products currently on the market differ from Cholestin in their chemical makeup and some contain a potentially toxic compound called citrinin. Until further information is available, red yeast rice products other than Cholestin cannot be recommended.
Other herbs that may be helpful
- Achillea wilhelmsii: In one study, patients with elevated cholesterol took a tincture of Achillea wilhelmsii, a traditional Persian herbal medicine. The patients used 15-20 drops of the tincture 2 times a day for 6 months. At trial's end the subjects had marked reductions in total cholesterol, triglycerides, and LDL cholesterol, as well as an increase in HDL cholesterol, compared to placebo. No side effects were reported.
- Artichoke (Cynara scolymus) (320 mg of standardized leaf extract two to three times per day for at least six weeks): Artichoke has moderately lowered cholesterol and triglycerides in some, but not all, reports.
Footnotes & Research
316. Oster, K., Oster, J., and Ross, D. "Immune Response to Bovine Xanthine Oxidase in Atherosclerotic Patients." American Laboratory, August, 1974, 41-47
317. Oster, K., and Ross, D. "The Presence of Ectopic Xanthine Oxidase in Atherosclerotic Plaques and Myocardial Tissues." Proceedings of the Society for Experimental Biology and Medicine, 1973.
318. Cholesterol-lowering effect of beta-glucan from oat bran in mildly hypercholesterolemic subjects may decrease when beta-glucan is incorporated into bread and cookies.
319. Journal of Nutrition, vol.128, pgs.1731-6, by Drs. Meehye Kim &Hyun Kyong Shin, Korea Food and Drug Administration and the Dept. of Food, Science and Nutrition, Hallym U., Chunchon, Korea