Cholesterol is produced in the liver and is required for the production of hormones, vitamin D, and bile acids. Cholesterol doesn’t dissolve in blood. To be transported in the bloodstream, cholesterol is packed into two types of carriers: low-density lipoprotein (LDL) or high-density lipoprotein (HDL). LDL cholesterol is necessary in limited quantities, but high LDL cholesterol levels can dramatically increase your risk of heart attack by contributing to atherosclerosis. Although high cholesterol is commonly addressed with statins, it is important for people to understand that lipid abnormalities are not caused by a “statin deficiency.” Rather, they are usually the result of dietary factors, particularly the inclusion of animal foods and oils and the absence of soluble fiber in the diet. Statins can help lower cholesterol levels; however, they can also produce adverse effects in people. Possible side effects include headache, difficulty sleeping, muscle aches and weakness, memory loss, neuropathy, high blood sugar, and an increased risk of developing diabetes. Can diet be just as effective as statins at lowering cholesterol, without the side effects?
Soluble fiber helps to lower blood cholesterol levels. It dissolves in water to form a gel that moves slowly through the intestines, “grabbing” up fat, dietary cholesterol, bile salts, and sugar to be excreted. Once excreted, these are no longer available to build more cholesterol.
Load up on foods high in soluble fiber like beans, such as hummus, lentil stew, dal, bean burritos, bean soup, bean burgers, bean dips. There are endless options to incorporate beans into your diet. Oats and barley are also high in soluble fiber. Try having steel-cut or overnight oatmeal for breakfast, use rolled oats to make pancakes, or make a delicious barley risotto. Incorporate soluble-fiber-rich vegetables like eggplant, okra, carrots, and potatoes into your diet to help lower cholesterol. This also includes dark, leafy greens such as kale, spinach, and collard greens. Pectin is a soluble fiber that works by binding to fatty substances in the digestive tract, including cholesterol, and promotes their elimination. Pectin-rich fruits such as apples, grapes, citrus fruit, and strawberries can help lower LDL.
Whole or minimally processed soy products (edamame, miso, tofu, tempeh) can be used to displace meat, dairy, or eggs from the diet and, in so doing, they help reduce the intake of saturated fat and cholesterol. We are not referring to soy products containing isolated soy protein, which is a plant fragment and not a whole soy food. Clinical trials have demonstrated that individuals eating whole soy products have LDL reductions of up to 11 mg/dL and total cholesterol reductions of approximately 7.5%. Soy isoflavones also have inhibitory effects on cholesterol synthesis, and the fiber content of whole soy foods promotes cholesterol excretion.
Dietary saturated fat intake has been shown to increase LDL cholesterol. Saturated fats occur naturally in many foods; dairy products, meat/seafood, and eggs contain both saturated fat and cholesterol. Dairy products are the leading source of saturated fat in Western diets. Avoidance of even low-fat dairy products is helpful for control of lipids, given that these cause small but significant increases in LDL.
Plant-based foods that contain saturated fats include coconut, coconut oil, coconut milk, and cocoa butter, as well as palm oil and palm kernel oil. Despite intense commercial promotion of some of these products, their effect on blood lipids is similar to that of animal-derived saturated fat. Coconut oil proponents try to argue that coconut oil has medium chain triglycerides (MCTs) which are shorter-chain saturated fats that aren’t as bad as the longer-chain saturated fats in meat and dairy. But you can’t apply the MCT research to coconut oil. MCTs make up only about 10% of coconut oil. The majority of coconut oil is the LDL-raising longer-chain saturated fats, lauric and myristic.
Trans fats are a form of unsaturated fat. There are two types: natural and artificial trans fats. Natural trans fats make up 3%–7% of the total fat in dairy products, such as milk and cheese, 3%–10% in beef and lamb, and 0%–2% in chicken and pork. Artificial trans fats are mainly formed during hydrogenation, a process in which hydrogen is added to vegetable oil to form a semi-solid product known as partially hydrogenated oil. Artificial trans fats can be found in some fried fast foods, processed bakery products, microwave popcorn, pizza dough, and non-dairy coffee creamer. Studies have linked consumption of trans fats to higher LDL cholesterol and lower HDL cholesterol levels. Though the FDA’s ban of trans fats went into effect in 2018, products manufactured before this date can still be distributed until January 2020, or in some cases 2021. Additionally, foods containing less than 0.5 grams of trans fats per serving are labeled as having 0 grams of trans fats. Be sure to read the ingredient list of packaged products to make sure partially hydrogenated oil is not in the product.
Coffee intake is associated with an increase of 8 mg/dL in total cholesterol and a 5.4 mg/dL increase in LDL, and unfiltered coffee is responsible for these effects to a greater extent than filtered coffee. French press or Turkish coffee lets through cafestol, which raises levels of LDL. Filters, used in drip coffee, seem to remove most of the cholesterol-boosting substances found in coffee.
If you have transitioned to a whole food, plant-based diet and still have high LDL, you may want to take a closer look at your family history, diet, and lifestyle.
Most cases of high cholesterol are not caused by a single inherited condition but result from a combination of lifestyle choices and the effects of variations in many genes. Familial hypercholesterolemia (FH) occurs because of a genetic defect on chromosome 19. It’s an inherited disorder that makes it harder for your body to remove LDL cholesterol from your blood. However, your genes are not your destiny, and the first line of treatment for FH is lifestyle modification.
Lower Your Fat Intake
For those with FH and those plant-based folks who still have a higher LDL, it is important to consume a low-fat whole food, plant-based diet. Make sure you’re limiting whole plant sources of saturated fat, including coconut products. Removing all added oil from your diet can really impact your LDL number. Consider that all oil — even the finest olive oil — is 100% fat, and 14% of it is saturated. Oil immediately suffocates the fragile endothelial cells of the arteries and vessels and keeps them from moving freely. It is very easy for our bodies to store this fat, and it can also stay in the blood vessels, adding to plaque. Oil is not a natural food. It is an isolated and concentrated part of a plant, extracted. So it has no fiber to mitigate how quickly it gets into the blood. Even a small amount of added oil can negatively impact your LDL cholesterol.
Being physically active is another way to maintain healthy cholesterol levels, particularly for strength training, aerobics, and high-intensity exercise such as HIIT (high-intensity interval training). However, even low-intensity exercise has been shown to increase HDL’s anti-inflammatory and antioxidant capabilities. Exercise can also help to lower LDL cholesterol when combined with dietary changes and weight loss.
Diet or Statins?
When researchers tracked health data in 328 adults who were not on statins but were eating a whole food, plant-based diet, they found that the group lost an average of 50 pounds and also saw their LDL cholesterol drop by an average of 42.2 mg/dL – without any medication. Statin drugs are not the answer for everyone with high cholesterol. A whole food, plant-based diet is a powerful, effective, risk-free approach, which not only results in great numbers, but also reverses the underlying disease.
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