High Cholesterol, Diet & Nutrition Discussion
Nutrition to lower high cholesterol has been found, by research, to have varied value. But some basics are important.
PLUS: Nutritional & Lifestyle Discussion
Most studies21 report that consuming fish increase HDL cholesterol20 which is known as the "good" cholesterol, and that this is tied to lower risk of cardiovasuclar problems. Fish does not contain much saturated fat and fish oil includes DHA, EPA and the important omega-3 fatty acids that lower cardiovascular risk.23
Research has demonstrated that vegetarians experience lower cholesterol levels24 and fewer cardiovascular illness reports25 than people who consume meat. This is partly because vegetarians are not consuming highly saturated animal fats. People who consume not only no meat, but also no dairy and eggs (vegans) have the lowest levels of cholesterol.26 It has been found that, along with other changes to lifestyle, changing from a meat-eating diet to a vegan diet can even reverse cardiovascular disease.27, 28
Egg yolks contain a lot of cholesterol - a major source of cholesterol in most diets. Consuming eggs has been demonstrated to raise serum cholesterol29 but not as much as consuming high saturated fatty foods. If the general diet is very low fat, then egg consumption may not raise cholesterol at all.30
However, when eggs are cooked and/or exposed to air they oxidize and cholesterol that has oxidized cholesterol is connected to higher cardiovascular disease risk.31 In addition, research has indicated that consuming eggs makes LDL cholesterol more vulnerable to damage and consequently, increases cardiovascular disease risk.32
The risk of death due to eating eggs is very controversial and there are conflicting preliminary studies espousing both sides of the issue.33, 24 Eggs contain nutrients that help fight heart disease such as protein, vitamins B12 and D, folic acid and riboflavin. Medical professionals currently conclude that those people who have trouble keeping their LDL and total cholesterol levels low should be careful about consuming egg yolks.
In most trials, soluble fiber (digested in the colon) has decreased levels of cholesterol.39 40 This includes beans,35 psyllium seed,37 oats,36 pectin from fruit38 and glucomannan. These foods are often recommended by medical professionals. In addition, insoluable fibers contained in grain (fermented in the large intestine) do not lower levels of cholesterol but have been tied to a lowered risk of cardiovascular problems.41 Therefore it is probably a good idea to increase all types of fiber in your diet, at least as much as 20grams additional per day for people who are not vegetarians (who get lots of fiber in their diet).42
Fiber - Oat Bran
Oat bran is quite rich in beta-glucan, one of the soluable fibers. The USDA ruled that oat bran could be registered as a cholesterol-reducing food at an if it added 3 grams of beta-glucan daily to the diet. Some researchers feel that this is not enough to make a difference.43 Several studies have have demonstrated that supplemeting with oat bran44-46 and oat milk47 may markedly reduce cholesterol levels in people with high cholesterol.48
Fiber - Flaxseed
Preliminary research has demonstrated that flaxseed, also a soluable fiber, reduces both total and LDL cholesterol.49 50 Another double-blind study found that total cholesteral were lowered by both sunflower and flax seed, but that only flaxseed markedly lowered LDL.51
Another controlled trials examined effects of partly de-fatted flaxseed, which had 20 grams of fiber/daily, and found that it lowered LDL cholesterol significantly. These indicate that the fiber in flaxseed, rather than the oil, is a cholesterol-reducing factor.52,53 54 55 The amounts of flaxseed typically used ranges from 30-50 grams/daily.
Fiber - Glucomannan
Konjac root, also known as devil's tongue or elephant yam, comes from tropical Asia and provides glucomannan is a water-soluble fiber. Double-blind154 155 and controlled152 153 research has shown that glucomannan supplements markedly reduce LDL cholesterol, total blood cholesterol, and triglycerides. Sometimes it also appeared to elevate HDL cholesterol. Medical professionals recommend 4-13 grams/daily as effective supplementation levels.
In nine double-blind preliminary trials beta-hydroxy-beta-methylbutyrate (HMB) supplementation was found to lower LDL and total cholesterol.156 3 grams/daily, for 3-8 weeks was used in the trials.
Alpha-linolenic acid (ALA)
ALA is an important fatty acid in both flax seed and flax seed oil. It is an omega-3 fatty acid converts to EPA, another fish oil fatty acid that appears to lower the risk of cardiovascular disease. While ALA does convert to EPA naturally through the body's system56 it does not lessen another cardiovascular risk factor, triglyceride levels.57
Early research on flaxseed ALA effects yields conflicting results. While ALA improves arterial health it may also damage to LDL cholesterol58 -- precursor to cardiovascular problems.
The "Mediterranean" Diet
See more information and research on the Mediterranean Diet in the artherosclerosis section.
While levels of cholesterol only fell modestly in the "Mediterranean" diet research, positive results in terms of cardiovascular problems suggest that patients with high levels who are concerned about their cardiovascular system's health should consider the diet. The diet is high in peas and beans, fish, vegetables and fruit, cereals and bread, and low in fat from meat, dairy products, and eggs.
Tempeh, some seiten, tofu, and miso, as well as soy-based protein powders are helpful because soy has been found to lower both LDL and total.62 A number of other controlled studies have substantiated results.63-66 Where results yielded statistically significant lowered cholesterol, more than 30grams/daily of soy protein has been consumed if animal protein is included in the diet. When dietary soy completely replaces animal protein, smaller amounts, 20grams/daily markedly reduces both LDL and total cholesterol.67 Soy beans contain isoflavones, Isoflavones found in soy beans seem to be the one of main ingredients soy beans contain68-71
More recent results substaniate that supplementing with soy lowers cholesterol in humans.191 and soy preparations with low levels of isoflavone (less than 27mg/daily) do not.192 As is often the case, contradictory research results suggest that supplementation with either soy193 or non-soy isoflavones (from red clover)194 in pill form may not be responsible for the cholesterol-lowering effects of soy. Further trials these supplements with isoflavone are needed.
Soy contains phytosterols, naturally occuring plant compounds. One such molecule, beta-sitosterol, is available as a supplement. Beta-sitosterol by itself, and combined with with other similar plant sterols, has been demonstrated to lower levels of blood cholesterol in preliminary195 and controlled196 trials. This effect may happen because beta-sitosterol blocks cholesterol absorption.197
Olive oil has been found to lower levels of LDL cholesterol,88 89 primarily when it replaces dietary saturated fat.90 Populations of countries using significant amounts of olive oil in their diets seem to be at much lower risk for cardiovascular disease.91 A number of double-blind trials and research studies have found this to be true, lowering cardiovascular risk by 25% (compared to 12% lower in low-fat diet)92 while still maintaining stable HDL cholesterol levels (decreased by 4% in low fat diets). Of course, like any oil or fat olive oil has lots of calories, so overweight people should limit its use. In addition, it has been reported that when heated above 185 degrees, olive oil, like many other cooking oils, releases some toxins, so it should be used for slow sizzles, not high-heat cooking.
Consuming garlic has been found to help to lower levels of cholesterol in some research,103 but not all research.104 105 106 and the relationship between garlic and lowering cholesterol lowering is unproven.108 Garlic, however, has blood thinning capacity 109 and may so may lower other risks for cardiovascular disease.110 Therefore, some medical professionals do recommend consuming garlic, taking 900mg (capsules) or 2 to 4 ml, (tinctures) three times a day.
Garlic research in the 90s reported that levels of cholesterol reduced by an average of 9-12% and triglycerides by 8-27% over a 1-4 month period285-287 using 600-900mg/daily garlic supplements. Contradictory trials reported poor results288-293 for various reasons. Therefore garlic consumption is not recommended by most medical professionals as a primary approach to reducing levels of cholesterol and triglycerides.
Part of the contradiction may be because not all garlic preparations are the same. There are differing effects from dissimilar garlic products. Generally garlic oil and aged garlic extracts (with no allicin) are not effective294 295 but enteric-coated, odor-controlled, tabs which have standard allicin contents are available and, in some trials, may be more promising.296
Research has consistently shown that consuming nuts significantly reduces cardiovascular disease risk.111 112 The beneficial effect may be partly because nuts lower cholesterol levels. research demonstrating that nut consumption lowers cholesterol levels113 114 and walnuts117-119 and almonds115 116 may be the best. Next in cholesterol-lowering value seem to be pistachio nuts125, hazelnuts124 and possibly macadamia nuts.120-123
Why are nuts effective? Some doctors think nuts are helpful simply because people who consume them are less likely to eat eggs, trans-fatty acids from processed foods and dairy products. However, nuts are comprised of many elements that are likely helpful to reduce cardiovascular disease risk, such as vitamin E, fiber, oleic acid, alpha-linolenic acid (mostly in walnuts), potassium, magnesium, and arginine.
In any case research results are very consistantly positive even though nuts are full of calories.129 Interestingly, one study found that adding hundreds of calories daily from nuts for six months did not raise body weight128 or increased it far less than might be expected.130.
Moderate alcohol consumption (1-2 drinks daily) increases protective HDL cholesterol.82 This effect happens equally with different kinds of alcohol-containing beverages.83 84 Alcohol also acts as a blood thinner,85 an effect that, in theory, should lower cardiovascular disease. However, alcohol consumption is correlated with liver disease (e.g., cirrhosis), cancer, high blood pressure, alcoholism, and, at high intake, an increased risk of cardiovascular disease. As a result, some doctors never recommend alcohol. Nevertheless, those who have one to two drinks per day appear to live longer86 and are clearly less likely to have cardiovascular disease.87 Therefore, some people at very high risk of cardiovascular disease - those who are not alcoholics, who have healthy livers and normal blood pressure, and who are not at high risk for cancer, particularly breast cancer - are likely to receive more benefit than harm, from light drinking.
Number and size of meals
Another interesting factor is that consuming many small meals, blood cholesterol levels are much lower than if the same amount of food is consumed in three large meals.131-132
It is well known that exercise, even walking, raises levels of protecting HDL cholesterol,133, 134 LDL and total cholesterol also lowered through exercise, more so if the patient loses weight at the same time.135 People who exercise regularly enjoy a fairly low cardiovascular disease risk rate.136 Patients above 40, or those who do have cardiovascular disease, should consult with their medical professional before beginning an exercise program because over-exercising may trigger a heart attack.137
Nutritional Supplement Treatment Options
Some of these nutrients are helpful, for others the evidence is incomplete or contradictory.
Vitamin C seems to help prevent free radical damage to LDL cholesterol157 and in some trials, when patients with high cholesterol supplement with vitamin C the levels reduce158 mostly in LDL cholesterol.159 The recommended dosage bringing the best protection seems to be with as little as 100mg/daily.160
Pantethine is a byproduct of pantothenic acid (vitamin B5) which may help lessen cholesterol development. A number of preliminary161-165 and 2 controlled166 167 studies reported that 300mg/2 to 4 times daily dramatically lessens levels of blood cholesterol may help raise HDL as well. However, in one study where patients who has diet-and drug-therapy resistant high cholesterol also did not find results with pantethine supplementation.168 Vitamin B5 by itself apparently does not affect blood cholesterol.
Chromium/ Brewer's Yeast
Supplementation with chromium been found to reduce LDL171-172 and total cholesterol,169 170and raise HDL cholesterol173-174 in most, but not all studies.175 176 One double-blind study determined that chromium (500mcg/daily) along with daily exercise was very effective, resulting in almost 20% lower total levels in only 13 weeks.177
Brewer's yeast, which includes quickly absorbable and biologically active chromium, has also been found to reduce blood cholesterol.178 Patients with high chromium blood levels seem to have a reduced risk of cardiovascular problems.179 Most health professionals recommend 200mcg/daily. Patients who want to consume brewer's yeast instead should obtain products specifically labeled "from the brewing process" or "brewer's yeast," because other forms do not contain chromium. True brewer's yeast should include up to 60mcg/ tablespoon, and recommended consumption is 2 tablespoons daily.
Niacin - Vitamin B3
Niacin, a form of B3, given as a supplement several grams/daily lowers cholesterol and is often prescribed for that purpose.180 Niacinamide another form of B3 does not accomplish that. In addition some niacin formulations raise HDL even better than some prescribed drugs.181 Some doctors prescribe 3 more grams for patients, but at these high levels symptoms such as headaches and flushing and serious problems such as liver damage or diabetes can result, so these levels should be taken only when monitored by your health professional.
While it is true that flushing and other symptoms are lowered with time-released niacin, serious problems like liver damage and still occur.182-186 There is one form of prescription-only part time-release niacin which lessens LDL and raises HDL without common symptoms and side effects.187
Some holistic health professionals recommend 500-1000mg inositol hexaniacinate 3 times a day instead of niacin.188 189 This specific form reportedly lowers blood serum cholesterol and thus far is not reported to create problems190 but there is very little research on the possible side effects of inositol hexaniacinate so again, this should only be taken under your medical professional's guidance.
Beta-sitosterol - Sitostanol
Sitostanol is a man-made molecule similar to beta-sitosterol, reduces levels of cholesterol and has been made available in a special margarine. Research has demonstrated that supplementing with 1.7 grams daily of this margarine along withe other dietary changes resulted in 24% reduction in LDL compared to 9% drop due to diet alone.199 This result has been substantiated by other research.200-204 Cardiovascular disease risk is reduced about 25% by using this sort of spread with sitostanol.205
Tocotrienols are part of the vitamin E family of vitamins that arise from naturally from certain foods such as wheat germ, specific oils and specific nuts and grains. Research results are contradictory as to whether these compounds reduce cholesterol in humans as they do in test-tube trials. 206-211
Copper deficiency is tied to elevated cholesterol..212 213 Supplementing for 8 weeks with 3-4mg copper was found in one study to reduce both total and LDL cholesterol.214
Beta-glucan is a soluble fiber (digested in the colon) which comes from the cell walls of baker\92s yeast, barley, and oats, as well as a number of medicinal mushrooms, such as maitake. It is the key to reducing cholesterol in oat bran215-218 These soluble fibers bind cholesterol to them so that they can be eliminated through the feces.219-221 Research indicates that after 4 weeks, both oat- and yeast-based beta-glucan typically reduce total cholesterol about 10% and LDL cholesterol about 8%. Likewise HDL levels are raised up to 16%.222-226
Some research has demonstrated that calcium lowers levels of cholesterol227-229 It could be that calcium binds to fat in the diet preventing it from being absorbed.230 Contradictory research has not found significant results.231 Most medical professionals who recommend calcium suggestion 800-1,000mg/daily.
Like other supplements testing, trials have found contradictory results for vitamin E in reducing cholesterol levels and raising HDL levels.232-235 Vitamin E is known, however to avert damage to LDL cholesterol.236 Most medical professionals now agree that it is LDL which has been damaged that raises cardiovascular problems risk. At the same time, studies vitamin E and prevention of cardiovascular disease also been contradictory.237 Even so, many cardiologists continue to suggestion supplementation with 400IU/daily to lower heart attack risk.
The heart muscle uses L-carnitine turn fat into energy. Some research suggests that this supplement reduces cholesterol238-240 It has been noted that increases are seen in HDL cholesterol after supplementing with carnitine.241 242 Patients apparently have a better chance of surviving a heart attck if they receive L-carnitine supplementation in trials.243 The recommended dosage is 1-4grams/daily.
Magnesium is necessary for normal heart functioning. The mechanism is not clear, but supplementing with magnesium (430mg/daily) reduced cholesterol in one trial.244 Another study demonstrated that a magnesium deficiency is connected to reduced levels of HDL.245 In addition, intraveneous magnesium has lowered the number of deaths following heart attacks in some trials.246 While these results seem to indicate that high cholesterol patients should supplement with magnesium one double-blind study of cardiovascular disease patients had more heart attacks after such supplementation.247 More research is clearly needed.
In trials and studies over time chondroitin sulfate been found to both reduce levels of serum cholesterol248 249 and reduce the risk of heart attacks. 250 Some medical professions who know about these studies recommend patients with high cholesterol or heart disease to take about 500/mg three times a day.
Lecithin refers generically to a group of fatty molecules from animal or plant sources. While lecithin reportedly raises HDL and reduces LDL cholesterol,251 this beneficial result may be due to its polyunsaturated fat content.252 An animal studio, however, did find a reduction in cholesterol from lecithin which had been stripped of its polyunsaturated fat content.253 Other research found changes one way or another.254
Chitosan comes from the outer-skeleton/skin of crustaceans such as shrimp. This fiber-like supplement has been found to lower blood cholesterol in some research.255 In another trial, it was found that 3-6grams/daily for 2 weeks caused a reduction of 6% in total cholesterol and 10% increase in HDL.256 Another study found contradictory results.257
Royal jelly is produced by bees in the process of nourishing young bee larvae. It has been found to stop the effect of nicotine's raising cholesterol258 and in animal studies, to reduce blood cholesterol levels.259 This has been validated in human trials.260 261 The recommended dosage (used in trials) is 50-100mg/daily.262
Red Yeast Rice
Red yeast rice contains monacolin K. Researchers have found that it slows cholesterol production through reducing enzyme action in the liver which creates cholesterol.273
Lovastatin (Mevacor®) behaves similarly and contains a much larger amount of monacolin.274 Therefore, researchers believe that red yeast rice may have other ingredients, such as sterols, that may also contribute to lowering cholesterol.
Red yeast rice has been tested in lab animal research275 and has been clinically evaluated in two double-blind trials. In a Chinese trial, both men and women taking 1.2 grams (containing approximately 13.5 mg total monacolins) of a concentrated red yeast rice extract per day for two months had significant improvements in total, LDL, and HDL cholesterol levels and in triglyceride levels.276 In a U.S. double-blind trial, a similar red yeast rice product in the amount of 2.4 grams per day (approximately 10 mg total monacolins) significantly decreased total, LDL, and triglyceride cholesterol levels but did not affect HDL values.277 Red yeast rice is commercially available in capsules and is typically used at 2.4 grams (approximately 10 mg monacolins) per day for a trial period of up to 12 weeks. If successful after this period of time, it may be used for long-term management of high cholesterol.
Psyllium seed as a cholesterol reducing agent has been greatly. A 1997 meta-analysis came to the conclusion that 10grams/daily reduced LDL cholesterol by 9% and levels of total cholesterol by 5%.278 A large controlled trial in 2000 determined that 5.1grams twice a day markedly reduced both blood cholesterol LDL.279 The recommended dosage is 5-10 grams/daily in the diet. Combining psyllium and oat bran may also be effective for LDL..280
Guggul produces a resinous sap, gum guggul. Gum guggul's extract, gugulipid is used in Ayurvedic medicine for high cholesterol and for atherosclerosis prevention. Researchers have found that it reduces blood cholesterol by 17.5%.281 Another study found that it had more benificial results compared to clofibrate, with slightly greater reduction in cholesterol levels and HDL levels increasing for 60% of the patients (while clofibrate did not change HDL.282 Aanother study noted marked changes in total and LDL cholesterol levels, but not in HDL.283 Recommended dosage is determined by the amount of guggulsterones in preparations, with 25mg/three times of day of guggulsterones. It generally takes 12 weeks before any results can reasonably be evaluated.
Achillea, or yarrow, is a common North American and European flower is also known as bloodwort. Research has found that patients with moderately high cholesterol receiving 15-20 drops twice a day for 6 months have marked reductions in total and LDL cholesterol and triglycerides and raised HDL levels.284 No side effected were noted.
Research has demonstrated that green tea (with large amounts of polyphenols) lessens total cholesterol levels, decreases LDL and increases HDL cholesterol.297-300 However, it doesn't necessarily lower lipid levels.301 Note that most of the research is based on the average three cups a day of green tea commonly consumed in the east. This amount provides 240 to 320mg of polyphenols.
Fenugreek seeds include steroidal saponins which inhibit cholesterol formation in the liver and absorption of in the intestines.305 Fenugreek's fiber may be factor in these results. A number of studies find that fenugreek may reduce total cholesterol in patients with moderate atherosclerosis306-308 and (defatted) may reduce good HDL levels. 309
Another small trial reported that either 25-50 grams/daily of defatted fenugreek powder markedly lowered serum cholesterol after 20 days.310 It is also thought that sprouting the seeds may improve their soluble fiber content and further enhance their beneficial effect.311 The recommended dosage is 10-30 grams/twice daily with meals.
Other Herbs & Nutrients
Research suggests that a number of other herbs may have beneficial effects but more research is needed since the existing research is inadequate, too limited, or contradictory.
- Artichoke extract may provide moderate benefits but doesn't decrease triglycerides or raise HDL.303-304
- Fo-ti (Chinese knotweed) high doses (12 grams/daily) may reduce levels of cholesterol.
- Wild Yam may raise HDL.312
- Maitake Mushroom may lower fat levels in blood.313
- Alfalfa saponins may block cholesterol absorptoin and prevent plaque development, but high amount of seed necessary for consumption might damage red blood cells.314, 315
- Octacosanol, is a fatty alcohol found in many plants' foliage and in wheat germ oil. A few studies have reported beneficial changes, 265-268 but other independent trials contradict the findings.
- Creatine reduced total cholesterol and triglycerides but left LDL and HDL unaffected.263 Another study contradicted these findings.264
MINUS: Dietary & Lifestyle Discussion
Eating sugar has been reported to reduce protective HDL cholesterol72 and increases other risk factors linked to cardiovascular disease.73 However, higher sugar intake has been associated with only slightly higher risks of cardiovascular disease in most reports.74 Although the exact relationship between sugar and cardiovascular disease remains somewhat unclear, many doctors recommend that people with high cholesterol reduce their sugar intake.
The 'cons' of coffee for people with high cholesterol: Drinking boiled or French press coffee increases cholesterol levels.75 There is a strong connection between consumption of more than one cup of coffee a day and heart disease, and is tied to higher homocysteine rates - a risk factor for heart disease and drinking decaffeinated coffee may not make any difference in risk75-83 There was no difference between light and medium roasts of coffee.154 Some researchers found that paper-filtered coffee did raise total cholesterol.154
The 'pros' of coffee for people with high cholesterol: Some researchers found that modern paper coffee filters trap the offending chemicals and keep them from entering the cup, and so lowering cholesterol levels.76 77 Some researchers concluded that paper-filtered coffee raises cholesterol and LDL, but does not raise homocysteine levels.154 Espresso coffee has amounts of the offending chemicals midway between those of other unfiltered coffees and paper-filtered coffee,78 The most recent research finds that favorable results depends upon compounds that are included in coffee, ie, chlorogenic acids are connected to decreased blood pressure, inflammation, diabetes, and platelet aggregation, and caffeine consumption has been tied to decreased body weight, blood flow improvement, and blood clot prevention.152 Where favorable benefits are found from coffee it is connected to drinking decaffeinated coffee, coffee taken along with lunch or dinner, rather than by itself for breakfast, and expresso production of coffee.320
In summary - there is plenty of research on all sides of the issue, and it may be that pesticides, preservatives and flavorings account for the mixed results. The best recommendations appear to be to usually not drink more than one cup of decaffeinated coffee, to drink it with lunch or dinner, and to drink organic coffee.
Eating animal foods containing saturated fat is linked to high cholesterol levels1 and cardiovascular disease.2 Significant amounts of animal-based saturated fat are found in beef, pork, veal, poultry (particularly in poultry skins and dark meat), cheese, butter, ice cream, and all other forms of dairy products not labeled "fat free." Avoiding consumption of these foods reduces cholesterol and has been reported to reverse even existing cardiovascular disease.3
Unlike other dairy foods, skimmed milk, nonfat yogurt, and nonfat cheese are essentially fat-free. Dairy products labeled "low fat" are not particularly low in fat. A full 25% of calories in 2% milk come from fat. (The "2%" refers to the fraction of volume filled by fat, not the more important percentage of calories coming from fat.)
In addition to large amounts of saturated fat from animal-based foods, Americans eat small amounts of saturated fat from coconut and palm oils. Palm oil has been reported to elevate cholesterol.4 5 Research regarding coconut oil is mixed, with some trials finding no link to cardiovascular disease,6 while other research reports that coconut oil elevates cholesterol levels.7 8
Despite the links between saturated fat intake and serum cholesterol levels, not every person responds to appropriate dietary changes with a drop in cholesterol. A subgroup of people with elevated cholesterol who have what researchers call "large LDL particles" has been reported to have no response even to dramatic reductions in dietary fat.9 (LDL is the cholesterol most associated with an increased risk of cardiovascular disease.) This phenomenon is not understood. People who significantly reduce intake of animal fats for several months but do not see significant a reduction in cholesterol levels should discuss other approaches to lowering cholesterol with a doctor.
Yogurt, acidophilus milk, and kefir are fermented milk products that have been reported to lower cholesterol in most,10 11 12 13 14 15 16 but not all, double-blind and other controlled research.17 18 19 Until more is known, it makes sense for people with elevated cholesterol who consume these foods, to select nonfat varieties.
Trans Fatty Acids & Margarine
Trans fatty acids (TFAs) are found in many processed foods containing partially hydrogenated oils. The highest levels occur in margarine. Margarine consumption is linked to increased risk of unfavorable changes in cholesterol levels93 and cardiovascular disease.94 Margarine and other processed foods containing partially hydrogenated oils should be avoided.
However, special therapeutic margarines are now available that contain substances, called phytostanols, that block the absorption of cholesterol.95 The FDA has approved some of these margarines as legitimate therapeutic agents for lowering blood cholesterol levels. The best-known of these products is Benecol®. The cholesterol-lowering effect of these margarines has been demonstrated in numerous double-blind and other controlled trials.96 97 98 99 100 101 102
Obesity increases the risk of cardiovascular disease,138 in part because weight gain lowers HDL cholesterol.139 Weight loss reduces the body's ability to make cholesterol, increases HDL levels, and reduces triglycerides (another risk factor for cardiovascular disease).140, 141 Weight loss also leads to a decrease in blood pressure, which reduces the risk of cardiovascular disease in people with high blood pressure.
Smoking is linked to a lowered level of HDL cholesterol142 and is also known to cause cardiovascular disease.143 Quitting smoking reduces the risk of having a myocardial infarction.144
The combination of feelings of hostility, stress, and time urgency is called type A behavior. Men,145 146 but not women,147 with these traits are at high risk for cardiovascular disease in most, but not all, studies.148 Stress149 or type A behavior150 may elevate cholesterol in men. Reducing stress and feelings of hostility has reduced the risk of cardiovascular disease.151
152. Coffee intake and cardiovascular disease: virtue does not take center stage, Montagnana M., et al, Seminars in Thrombosis and Hemostatis, March, 2012,
153. Relationship between plasma total homocysteine level and dietary caffeine and vitamin B6 intakes in pregnant women, Shiraishi M., et al, Nursing & Health Sciences, July, 2013.
154. Paper-filtered coffee increases cholesterol and inflammation biomarkers independent of roasting degree: a clinical trial, Nutrition, Carrea, TA, et al, July-August, 2013, 29(7-8), 977-981.
Related health condition: High Cholesterol