Chicago Tribune, 07-21-06
If you have high blood cholesterol - like an estimated 100 million Americans - then chances are you're trying to change the way you eat.
Your blood cholesterol level has a lot to do with your risk of getting heart disease, which remains the country's No. 1 killer. Diet often is the first defense before a doctor turns to drugs to lower cholesterol levels. Losing weight, exercising and cutting down on "bad" fats are the cornerstones of a cholesterol-lowering lifestyle.
Those basics haven't changed, but you may be surprised by some of the diet advice you'll likely get today.
"Nothing has to be totally eliminated," said dietitian David Grotto, a spokesman for the American Dietetic Association who frequently counsels clients with elevated cholesterol levels.
He says "everything can be negotiated" by keeping sight of portions and making simple trade-offs. "We can find ways to still include your favorite foods."
For starters, there may be no need to give up your sunny-side-up breakfasts. Eggs - the icon of cholesterol in food - were once thought to be a major contributor to heart disease. Now it appears that the cholesterol we eat is not the greatest influence on the cholesterol in our blood.
That honor goes to saturated and trans fats.
Recent studies have shown that eating up to one egg a day didn't raise cholesterol levels or increase the risk of heart disease in healthy people. If you have already have elevated cholesterol levels, three to four eggs per week are generally allowed, according to Grotto.
Eggs may be high in dietary cholesterol, but they don't contain much saturated fat. That also is true for cholesterol-laden shrimp and other shellfish, which typically are OK in moderation as long as they're not soaked in butter or deep-fried.
Nowadays, eating to lower cholesterol is as much about adding certain foods as it is about limiting others, said dietitian Elaine Trujillo, co-author of "Eating for Lower Cholesterol."
A new study published in the American Journal of Clinical Nutrition found that adding a specific combination of heart-healthy foods brought down cholesterol levels as much as first-generation statin drugs. The goal was to see if a "portfolio" of foods - each with its own minor cholesterol-lowering benefit - could have a larger effect when eaten together. It was the first study to examine the potential benefits of bundling four types of foods with an FDA-authorized health claim related to heart disease, according to lead author David Jenkins of the University of Toronto.
Participants ate a diet that was low in saturated fats but rich in viscous fiber (found in oats and barley), soy protein, almonds and plant sterol-fortified margarine. After 12 months, those who strictly followed the "portfolio eating plan" lowered their LDL, or "bad," cholesterol by 20 percent or more - comparable to the levels achieved by medication. Even the participants who frequently "fell off the wagon" achieved at least a 10 percent reduction in LDL cholesterol.
Jenkins said there was a powerful "additive effect" by combining these foods because they each work to lower cholesterol in the body in different ways. Check out the chart for the top cholesterol-lowering foods used in the study that you can incorporate into your menus.
Do you know your cholesterol numbers?
The American Heart Association recommends adults age 20 or older have their total cholesterol checked every five years. Many people have elevated cholesterol levels but don't know it. For more information on lowering blood cholesterol, visit americanheart.org.
A PORTFOLIO OF HEART-FRIENDLY FOODS
These are the four categories of cholesterol-lowering foods that helped lower "bad" cholesterol by 20 percent or more as part of a diet low in saturated fat.
-Viscous fiber: This "sticky" type of soluble fiber found in oats, barley, beans and certain vegetables such as okra and eggplant helps bind the cholesterol in your digestive tract and sweep it out of your body.
Why you need it: Eating 11/2 cups of cooked oatmeal a day typically produces cholesterol-lowering results. Including 10 grams of viscous fiber a day has been shown to decrease LDL cholesterol by about 5 percent. How to do it: Start your day with oatmeal or a psyllium-enriched cereal. Try bean and barley-based soups, marinated bean salad, hummus sandwiches, black bean burritos and roasted eggplant.
-Soy protein: Heart-healthy alternatives to higher-fat meats. With little or no saturated fat, they provide protein, fiber, "good" fats, vitamins and minerals.
Why you need it: Recent studies have questioned soy protein's ability to lower blood cholesterol - suggesting it has little or no effect on the risk factors for heart disease. The primary benefit may be eating fattier fare less often.
How to do it: Go meatless at least once a week - opting for soy-based products instead, such as soy sausages, burgers, franks, cold cuts and chicken patties. Snack on soy nuts and edamame, or fresh soybeans.
-Plant sterols: Compounds - typically extracted from soybeans or certain vegetables - so similar in structure to cholesterol that they "compete" in our intestines. That means less of the real cholesterol is absorbed.
Why you need it: Eating 2 grams of plant sterols each day can lower LDL cholesterol by about 10 percent. But you need to consume them every day for the cholesterol-controlling benefit to continue.
How to do it: Look for sterol-fortified products - including margarine-type spreads (Benecol, Take Control and Smart Balance) and some brands of orange juice, yogurt, cheese, salad dressings, granola bars and chocolate.
-Nuts: The handful of almonds that study participants ate each day provided cholesterol-lowering monounsaturated fat, plant sterols, fiber and vitamin E, an antioxidant.
Why you need it: Studies have shown that people who ate about a handful of almonds a day (or 1 ounce) lowered LDL cholesterol by 4 percent; those who ate two handfuls lowered it by 9 percent.
How to do it: Eat a variety of nuts, including walnuts, which pack in the most omega-3 fatty acids. Snack on nuts instead of pretzels or chips; toss chopped nuts into your oatmeal, salads and stir-fries.
-Source: American Journal of Clinical Nutrition, 2006