Improving your cholesterol levels for heart health means lowering your triglycerides, lowering your “sticky” LDL cholesterol (the bad kind), and increasing your protective HDL cholesterol (the good kind). For each 1% decrease in LDL, your cardiovascular risk may decrease by about 1%. However, for each 1% increase in HDL, your cardiovascular risk may decrease between 2% and 4%. HDL also appears to exert anti-inflammatory properties. (Circulation 2004;109:III20-26.)
So, reducing triglycerides and LDL cholesterol is desirable, but increasing HDL may be even more beneficial. Inflammation (or the stickiness of the LDL cholesterol) seems to be a higher risk factor than elevated levels of LDL (Circulation. 2003;107:363). One-half of all heart attacks occur in people with normal levels of cholesterol. Inflammation can be screened with a high sensitivity c-reactive protein (hsCRP) blood test. Lower levels of hsCRP (<1.0) predict a reduced risk for future cardiovascular events (as well as for diabetes and cancer). Raising HDL and reducing inflammation in the blood is very protective when it comes to cardiovascular health.
Consider the following recommendations for improving your cholesterol panel and your health:
1. Get more omega-3s and take CoQ10.
Take fish oil supplements with food daily to raise HDL and lower LDL, triglycerides and c-reactive protein (CRP). The American Heart Association recommends 2 - 4 grams (2,000 - 4,000 mg) daily of DHA + EPA to lower triglycerides; 1 gram (1,000 mg) daily of DHA + EPA for cardiovascular protection.
Also make an effort to eat more wild salmon or sardines, since they are low in mercury and high in beneficial omega-3 fatty acids. Sockeye (red) salmon has never been successfully farm-raised and also contains more astaxanthin than other salmon. Eating non-fried cold water oily fish or taking fish oil also reduces the risk of depression and helps arthritis as well.
A dosage of 90 mg CoQ10 daily was shown to increase available DHA blood levels by 50%. Note that statin drugs and red yeast rice supplements may deplete CoQ10 stores in the body. (J Clin Pharm. 1993; 33(3):226-229.)
2. Eat more avocados, nuts and seeds, and extra virgin olive oil.
These foods are rich in phytosterols (also known as plant sterols), naturally concentrated in plant foods that have been shown to effectively help regulate cholesterol levels. Phytosterols can also be taken in supplemental form.
Avocados are the fruit highest in a phytosterol called beta-sitosterol. Eating at least half an avocado daily for three weeks may help lower total cholesterol by 8% (compared to 5% with a low-fat diet), lower triglycerides and improve the HDL-cholesterol ratio by 15%. In one study, avocados lowered LDL 22%. Avocados contain about 76 mg of beta-sitosterol per 100 gm (about 3.5 ounces or 7 tablespoons of avocado). Sesame seeds, wheat germ and brown rice bran have the highest total phytosterol content (400 mg), followed by pistachios and sunflower seeds (300 mg), pumpkin seeds (265 mg) and pine nuts, flaxseeds and almonds (200 mg) per 100 gm serving. Almonds, 2 oz (56 grams) daily, lowered LDL 7% and increased HDL 6%. (J Nutrition. 2002; 132:4.)
Olive oil has about 22 mg per tablespoon of phytosterols (150 mg per 100 grams). Replacing saturated fats with monounsaturated fats such as olive oil can reduce LDL by as much as 18%. Olive oil (especially unfiltered) relaxes the endothelial wall after eating and reduces inflammation. Olive oil raised HDL 7% in one study of human volunteers, despite consumption of high glycemic index foods. Rice bran oil or grape seed oil have also been shown to improve LDL/HDL ratios.
3. Eliminate trans fats from your diet (from hydrogenated or partially hydrogenated oils).
Trans fats are found in many coffee creamers, Cool Whip, most margarines, most microwavable popcorn, and fried foods, as well as many processed foods, and most fast foods. Trans fats promote smaller LDL particles, which contribute more serious disease, and lower HDL.
In one review, 1% fewer calories daily from trans fats could reduce cardiovascular risk by at least 50%. This means that on a 2,000 calorie diet, removing 20 calories of trans fats (or 2 grams) would have a tremendous impact. Be aware that labels can still read “trans fat free” if the food contains less than 0.5 gram per serving, so look for the word “hydrogenated” or “shortening” in the ingredients. Even small amounts of trans fats strongly promote inflammation, diabetes, cardiac and cancer risk.
4. Get more magnesium.
Increase magnesium-rich foods, such as pumpkin seeds, wheat germ, salmon, soybeans and whole grains. Endothelial cells (lining arterioles) have less discrimination against the uptake of hydrogenated oils when exposed to a magnesium-deficient environment. And about 70% of residents living in the U.S. are estimated to be deficient in magnesium.
Magnesium is a neuromuscular relaxant. It also helps repair muscle injury, absorb calcium, lower blood pressure, and decrease migraine severity and frequency by about 40%. One review showed that magnesium actually acts like a statin drug, lowering LDL and increasing HDL, but without the side effects. (AJCN 2004; 23,5,501S-505S.) Since it is water soluble, consider getting either dietary magnesium or a supplement of about 250 mg twice daily (with or without calcium).
5. Eat less sugar.
Lowering the glycemic index of foods consumed over one week (average 46 vs. 61 on a sugar scale of 100) has been shown to increase HDL by 7%. One study showed three times higher hsCRP in women with the highest quintile of glycemic load compared to those with the lowest glycemic load (AJCN 2002; 75, 3, 492-498). Blood sugar surges sugar-coat red blood cells and vessel walls, and increases stickiness (glycosylation).
6. Increase your soluble fiber intake and add prebiotics and probiotics.
Oats and oat bran, brown rice bran, peas, beans (especially soybeans), lentils, flaxseed, okra and eggplant are good sources of soluble fiber. Oat bran (100 grams daily) lowered LDL 14% in hypercholesterolemic men (AJCN 1981; 34:824-9).
When non-digestible but fermentable fiber promotes certain beneficial bacteria (called probiotics) in the colon, then the fiber is called prebiotics (such as inulin, fructooligosaccharides or soy oligosaccharides). The addition of inulin to a moderately high-carbohydrate, low-fat diet helped plasma lipids by reducing hepatic lipogenesis and plasma triacylglycerol concentrations (AJCN 2003; vol 77, 3,559). Probiotics can decrease LDL (5 - 8% with strains of Lactobacillus acidophilus and bifidobacterium longum) and increase HDL by as much as 25% when prebiotics such as oligofructose or inulin are also used. (Eur J Clin Nutr 2000; 54: 288-297; Eur J Clin Nutr 2002; 56 (9): 843-849.)
7. Take vitamin D3.
Vitamin D, our sunshine vitamin, has been found to be extremely important for many reasons, and high doses are much less toxic than previously feared. Recent studies determined that even small doses of 500 IU vitamin D daily helped seriously ill patients reduce their CRP by 25%, and some patients report greatly increased HDL after supplementation. Elevated vitamin D levels are associated with reduced risk of death from all causes, including cardiovascular events.
Milk has 100 IU vitamin D per 8 oz; sockeye salmon has about 675 IU vitamin D3 per 100 gm (3½ oz.). Direct sunshine can produce 10,000 - 20,000 IU on a sunny day through bare skin (without sunblock), but the majority of those living in the U.S. appear to have insufficient levels (even in the southern U.S.). Many research scientists now request that we start supplementing 2,000 IU vitamin D3 daily, then consider screening a blood level of 25-(OH)vitaminD after 2-3 months to see how much more is needed.
Learn more by visiting GrassrootsHealth. (See especially the video with Dr. Michael Holick and the Disease Prevention Incidence Chart). Or visit Dr. John Cannelll at the Vitamin D Council. Do not take vitamin D supplements without a doctor’s supervision if you have sarcoidosis, liver, kidney or parathyroid disease. (AJCN 2006 Jul;84(1):18-28).
8. Eat more blue, purple and red fruits.
Polyphenols in blueberries, pomegranate, cranberries, red grapes and (extra virgin unfiltered) olive oil help raise HDL. Eating about 5 oz berries, puree or nectar daily (bilberries, lingonberries, black currants, strawberries, raspberries and chokeberries) x 8 wks increased HDL 5%. (AJCN. 2008, 87:2, 323-331.) After 1 month of drinking 6 oz. daily of pure cranberry juice (usually diluted with 3 parts water), HDL increased by 10% (Vinson JA. Cranberry juice increases plasma antioxidant and HDL cholesterol levels. Research presented at the 225th national meeting of the American Chemical Society, 3/24/03.)
This corresponds to about 20-40% reduction in cardiovascular disease. Consider mixing unsweetened cranberry juice with pomegranate, red grape and/or blueberry juice. Red wine has some controversy, since the HDL increase does not include the most beneficial subtype HDL-2B. Alcohol also can raise triglycerides, but the red grape skin and possibly crushed grapeseeds may reduce cholesterol. Grape seed extract is similar to pycnogenol; both may also play a role in reducing cholesterol. Since alcohol also contributes to hypertension, liver disease, breast cancer, weight gain, as well as addiction, and accidents, the American Heart Association does not advocate wine as an attempt to improve cholesterol. Resveratrol, found in red wine, red grapes, peanuts and FoTi (a Chinese herb) may be used as a supplement to get some of the same benefits.
9. Try something new.
Raise HDL with niacin (nicotinic acid), dark chocolate (minimum 70% cocoa mass), curcumin (extract of turmeric), kale (juiced) or hibiscus tea. Move calcium from arterial plaque into bones with vitamin K2. Lower LDL and cancer risk with Oriental mushrooms (cooked at least 5 minutes).
10. Exercise, relax and laugh more.
Exercise reduces inflammation, increases HDL, assists insulin in controlling blood sugar and reduces stress. Keeping physically fit (at least 30 minutes of exercise 4 - 5 times per week or walking over 130 minutes weekly) reduced the risk of dying from cardiovascular disease by about 50% regardless of cholesterol levels (Circulation. 2005;112:1478-1485).
In a sedentary older population, supervised exercise for 30 minutes 3 times per week for 6 months reduced CRP 15%, which is as much as statins. (Arteriosclerosis, Thrombosis, and Vascular Biology. 2004;24:1874). HDL-C increases with exercise. (Arch Int Med. 1995; 155;415-420.)
Relaxing and laughing helps, too. Rabbits fed an atherogenic diet had 60% reduced atherosclerosis when the student assigned to feed those rabbits also petted them. (Science. 1980; 208: 1475–1476.) Those with heart failure and mild depression had 44% higher probability of death over 5 years than those not depressed. After one heart attack, those assigned to watch one hour of funny videos or sitcoms daily had five times fewer second heart attacks in the next year. Laughing increases blood flow, lowers blood pressure and stress hormones.
Note: Lowering cholesterol too far can actually increase the risk of depression, aggression, and cerebral hemorrhage. Cholesterol is required to make brain cells, memory, fight infections and cancer (and make hormones, including vitamin D). The key is to reduce inflammation and oxidization of cholesterol with healthy diet, exercise and relaxing, and try to raise the beneficial HDL.
Click here to read Dr. Manuel's detailed list of 37 tips for improving your cholesterol levels without drugs.
Copyright © 2009 Peggy L. Manuel, MD FAAP
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