Improving Your Cholesterol Profile

By Rebecca K. Kirby, M.D., M.S., R.D.

The number one cause of death in the United States is heart dis ease. There are a number of risk factors that are associated with increasing your chances of being affected, and there are lifestyle and biochemical(nutritional) factors that can reduce these risks. We will discuss ways to naturally improve the cholesterol profile, but that is only part of the puzzle for improving heart health. Other pieces of the puzzle include the following: maintain a healthy weight, keep your blood pressure and blood sugar normal, stay active, and do not smoke. These lifestyle factors are so important that they can lower your chance of developing a major risk factor for heart disease such as diabetes, kidney disease, (peripheral) artery disease, hypertension, or metabolic syndrome (prediabetes).

It has been known for 50 years that plant sterols lower cholesterol.

There are risk factors such as family history, age, or gender that we cannot do anything about, but reducing the amount of fat around the middle is something we can impact. A waist circumference of over 40 inches for men and 35 inches for women is a risk factor for developing metabolic syndrome as well as heart disease. All of these risk factors also determine the degree to which the lipid profile is important and to what extent it may need to be lowered.

Studies show a lower cholesterol level may be beneficial in middle-aged men or those at high risk for coronary heart disease, but may not reduce mortality in women or those over 70 years of age without heart disease. It is important to keep the function of cholesterol in perspective and whether lower is always better. Low cholesterol levels in men and women over age 50 are associated with deaths through cancer, liver disease, and mental diseases. The Framingham Heart Study found that higher cholesterol was associated with higher mortality in subjects between the ages of 40 to 60, but not after age 70. High cholesterol levels are absent in almost half of all individuals who will ever have a heart attack or stroke. Cholesterol is necessary for brain function (8% of cholesterol is in the brain), and cholesterol is part of all cell membranes. Among other functions, cholesterol is a precursor for making vitamin D and steroid hormones.

When cholesterol is reported on a lipid panel, it will be broken down into particles called HDL (high density lipoproteins) and LDL (low density lipoproteins).In general, lowering the LDL can be beneficial and raising the HDL is not only beneficial but can negate a risk factor like age. Triglycerides will also be included in the report and should fall within the normal range (under 150); higher levels may indicate a tendency towards prediabetes.

To improve the lipids(cholesterol and other fats in the blood), studies have shown fish oils, fiber, plant sterols, niacin, red yeast rice, exercise, and nuts are all beneficial.

Consider the case of fish oils first. Consumption of the omega-3fattyacids, EPA and DHA, has been found to decrease the risk of heart attack and sudden death as well as death from any cause inpatients with known heart disease. Fish oil supplements can lower triglycerides by 30 to 50% if 2,000 to 4,000mg of EPA and DHA are taken daily. In addition, the American Heart Association recommends eating 2 fish meals a week and, if you have heart disease, to supplement with 1,000 mg of EPA/DHA omega-3 fatty acids from fish oil. Good dietary sources include fatty fish like salmon, mackerel, sardines, cod liver oil, or quality fish oil supplements.

Fiber consumption is inadequate in the U.S. with the average American eating about 11grams a day. The recommendation is 25 grams for women and 35 grams for men daily. Fiber can be insoluble like bran or soluble as in oat bran, beans(legumes), fruits, and barley. Studies have found that triglycerides can be lowered by eating 1 cup of navy and pinto beans daily or by replacing refined carbohydrates in the diet with 1.5 cups of mixed legumes (beans, peas, lentils).

Phytosterols, or plant sterols, are fats present in all plants and are similar to cholesterol in animals. It has been known for 50years that plant sterols lower cholesterol; products with plant sterols were even marketed in the 1950’s for that purpose. Studies have shown a 7 to 14% reduction in LDL-cholesterol which correlates to a 10 to 20% reduction in heart disease. Plant sterols are commonly added to foods called functional foods such as margarine-like spreads, yogurt, drinks, snack bars, orange juice, and salad dressings. Although people consume plant sterols every day in their normal diet in vegetable oils, nuts, and seeds, the amount is not great enough to have a significant cholesterol lowering effect. Consuming one to three grams of plant sterols daily is required; these amounts can come from functional foods or supplements.

Vitamin B3 (niacin)is available as both niacinamide and nicotinic acid, both of which will prevent pellagra, which is a severe deficiency of niacin. It is the nicotinic acid form, however, that is a cholesterol-lowering agent when consumed in pharmacologic doses, which means an amount higher than the vitamin effect of niacin.  Studies show that 1,000 mg three times a day after meals lowers total cholesterol, lipoprotein(a) and increases the HDL-cholesterol. Niacin causes flushing (vasodilatation), and it is best to start with smaller amounts and increase the dose as you develop
tolerance to the flushing. Visit with your doctor about starting a niacin regimen for lowering your cholesterol.

Red yeast rice is from rice fermented with a mold called Monascus purpureus that gives it the reddish color. It is used as a culinary dish and in traditional medicine in China. A product of the red yeast rice is a naturally-occurring statin called lovastatin. Trials have shown that 2.4 grams a day can significantly lower LDL-cholesterol. Statin drugs are known to interfere with the body’s production of coenzyme Q 10; therefore, since red yeast rice is a statin, it is advisable to also take coenzyme Q10 to avoid muscle fatigue side effects.

Exercise can lower your risk of heart attack or stroke with as little as 2 hours of physical activity a week. In the Women’s Health Study, a 41% risk reduction was found for women between the ages of 45 to 90 who performed 5 hours of moderate exercise a week.

Dietary changes to benefit heart health center on a low-fat diet. However, all fats are not to be condemned. Scientific evidence suggests that 1.5 ounces of nuts a day may reduce the risk of heart disease. Almonds, pine nuts, hazelnuts, pecans, peanuts, pistachio, and walnuts are all good sources of monounsaturated fatty acids.

Reducing your risk of heart disease requires a multifactorial approach which includes reducing inflammation. Don’t put all your eggs in one basket, thinking that lowering your cholesterol is all that you need to do. Remember those lifestyle changes of exercise, not smoking, and maintaining a healthy weight. In addition to a good diet, learn to manage stress and get more sleep. Live healthy and enjoy life.