Spotlight on High Cholesterol

What do almonds, tea, soybeans, and exercise have in common?
By Christie Aschwanden

On a routine visit to his doctor, Jerry Richardson*, a 54-year-old executive, got the unsettling news that his number was up: His total cholesterol level had soared to 280, well above the normal cutoff point of 199.

While other heart disease risk factors, such as arterial inflammation and homocysteine, have grabbed headlines of late, out-of-whack cholesterol levels still pose a grave danger to the heart: For every 1 percent that a person’s total cholesterol goes up, there’s a 2 to 3 percent increase in the risk of heart disease.

Richardson’s numbers were worrisome enough that his cardiologist prescribed a statin, a type of cholesterol- lowering drug that’s become the conventional therapy of choice in the past few years. (Annual sales are now in the $19 billion range.) The drugs are strikingly effective at cutting cholesterol levels and reducing the risk of heart attack and death.

But they aren’t trouble-free. They occasionally cause life-threatening side effects such as liver failure and a rare muscular disease called rhabdomyolysis. In fact, one statin—Baycol—was pulled from the market in August 2001 after the Food and Drug Administration received reports of 31 fatal cases of rhabdomyolysis among those taking it. More commonly, these drugs can bring on uncomfortable side effects like gas, heartburn, nausea, headache, and dizziness, among others.

Indeed, after taking the drug for a couple of weeks, Richardson developed muscular weakness and back pain, side effects he couldn’t imagine coping with for the rest of his life. So he promised his doctor, cardiologist Stephen Sinatra of the New England Heart & Longevity Center in Manchester, Connecticut, that he’d stick with any nondrug therapies he could recommend. Luckily, Sinatra had all sorts of possibilities to suggest, including dietary changes, supplements, and exercise.

“There are dozens of natural methods to lower cholesterol,” Sinatra says. “Anyone with total cholesterol higher than 200 or LDL higher than 130 can benefit from them. As long as high cholesterol levels are the only problem, natural is usually the way to go.” Anyone with highly inflamed arteries, though, or a history of heart disease will need to stick with statins, he says.

You can try natural therapies singly, or mix and match them; some combinations, in fact, can work just as well as the drugs. Sinatra cautions that whatever you decide to try, you should consult with your physician first. Your doctor will need to monitor your cholesterol levels every one to three months to see if the treatments are working and help you make adjustments to your regimen, if necessary. Here’s what’s worth trying.

Spread on a healthy fat 
Margarines have gotten a bad rap because the trans fatty acids they contain do even more artery-clogging damage than saturated fat does. But there’s one type that’s enriched with plant sterols, which reduce cholesterol absorption. It was touted for its cholesterol-lowering abilities when it came on the market several years ago, and a recent study in the American Journal of Clinical Nutrition bears out the hype.

In the study, people with mild to moderate high cholesterol followed a low-fat diet for four weeks, and then for the next five weeks were divided into groups that used either regular margarine or margarine with sterols. The Numbers: The sterol group had total cholesterol levels 5 to 6 percent lower than the regular group, and LDL levels 7 to 8 percent lower. Simply spreading a pat of sterol margarine—Benecol and Take Control are two popular options—on your breakfast toast should do the trick, says David Jenkins, a professor of medicine and nutritional science at the University of Toronto.

Take time for tea
It’s not a bad idea to pair your morning toast with a cup of tea, according to researchers at the USDA’s Beltsville Human Nutrition Research Center who asked people with mild high cholesterol to drink five cups of black tea daily. (Other research suggests that green tea may be helpful, too.)

The numbers: Tea drinkers in the study had an average drop of 5 percent in total cholesterol and 11 percent in LDL.

Go nuts 
All sorts of nuts are high in monounsaturated fats and vegetable protein, which can bring down cholesterol. Some of the best evidence comes from a study of men and women with high cholesterol in a recent issue of Circulation. The nuts did add extra calories to the volunteers’ diet—about 200 per handful. But no one gained weight, says Jenkins, probably because the nuts were filling, and people ate less of other foods to compensate.

The Numbers: Two handfuls of almonds a day for a month lowered study participants’ LDL cholesterol by an average of 9.4 percent and their total cholesterol by 12 percent. (One daily handful helped, too, but not as much.)

Eat more soluble fiber
There’s a good reason why the typically cautious FDA allows companies to put a health-related claim on products containing psyllium seed husks—they’re proven to lower cholesterol and reduce your risk of heart disease.

Psyllium-rich Metamucil gel capsules taken twice a day work well, says James Anderson, professor of medicine and clinical nutrition at the University of Kentucky in Lexington, as do psyllium-laced wafers and cookies. He suggests taking one dose (the amount is listed on the package) per day for a week, which will allow your bowels to adjust to the additional fiber, then taking two doses a day from the second week on, and continuing indefinitely.

The Numbers: In people with mildly to moderately elevated cholesterol levels, soluble fiber can boost the cholesterol-cutting effect of a low-fat diet, lowering total cholesterol by an additional 4 percent and LDL by an extra 7 percent.

Swap soy for meat 
Substitute tofu for cheeseburgers and not only will you cut your intake of cholesterol and saturated fat, you’ll also reap the benefits of a protein source that many studies have shown can improve your cholesterol profile. Researchers aren’t sure exactly which substances account for these powers, but they suspect that it’s the isoflavones and fiber.

“Find the soy products you like and gradually include them in your diet,” Anderson suggests. Options include soy milk, soy nuts, edamame (a tasty green soybean), and soy burgers and cheeses. Anderson recommends 20 to 25 grams of soy a day, taken in two or three servings. (Women with a history of breast cancer may want to consume less; check with a health practitioner.)

The Numbers:Soy protein can lower total cholesterol by an average of 9.3 percent and LDL cholesterol by 13 percent, studies have shown.

Get some supplemental assistance: guggulipid…
Among the most promising supplements is guggulipid, an Ayurvedic herb made from the sap of the Indian guggul tree. Virender Sodhi, an Ayurvedic and naturopathic physician at the Ayurvedic Clinic in Bellevue, Washington, recommends a product standardized for 10 percent guggulipids. Start by taking three doses totaling 900 milligrams a day, he says. Once your cholesterol levels are back to normal, he advises cutting the dosage to 300 mg a day.

The Numbers: Taking 50 mg twice daily can cut total cholesterol and LDL levels by 12 percent.

…and policosanol 
This cholesterol-buster is made from sugarcane, so it’s not surprising that much of the research on it has been done in sugar-rich Cuba. It’s a plant chemical similar to sterols. In one study, 589 people with high cholesterol took either policosanol or a placebo every day for a year. At the end of that time, those who got the real thing lowered their total cholesterol by an average of 15 percent and their LDL by 20 percent.

German researchers, too, have taken note: In a review of published studies, they state that 10-mg daily doses of policosanol work as well as statins at lowering total and LDL cholesterol; it also raises HDL, the “good” cholesterol that carries LDL out of the bloodstream.

The Numbers: Can cut total cholesterol by 15 percent and LDL by 20 percent, and can raise HDL by 8 to 15 percent.

Move about, twist and shout
While it’s long been known that exercise helps protect against heart disease by boosting HDL, experts didn’t think it affected LDL—until recently. But a new study shows that while exercise doesn’t decrease overall LDL levels, it does transform the riskiest type of LDL particles, those that are small and dense, into a more benign form. That makes the particles less dangerous, even if the overall LDL level stays the same.

The study also points to a specific amount of exercise that’s necessary to make that positive change: about 20 miles a week of jogging or low-intensity climbing on a StairMaster. (The researchers say that walking is probably equally beneficial, though they didn’t test this in the study.) If that sounds like too much, remember that even 10 to 12 miles’ worth will stop your cholesterol profile from getting any worse, says study author Cris Slentz, a research scientist in the Division of Cardiology at the Duke University Medical Center.

The Numbers: Regular exercise boosts HDL by as much as 10 percent, and can make your LDL cholesterol less dangerous.

Try a total diet makeover 
If you’re willing to make more radical changes in what you eat each day—building your diet around a combination of cholesterol-lowering foods and cutting way back on saturated fats—you can cut your cholesterol level drastically.

Jenkins and his colleagues put 13 people with high cholesterol (who had already trimmed their dietary fat) on such a “combined” diet for 30 days. A typical day’s meals might include a breakfast of soy milk and oat bran cereal with fruit and almonds; a lunch of soy cold cuts, oat bran bread, bean soup, and fruit; and a dinner of stir-fried vegetables, tofu, more fruit, and almonds.

The Numbers: After a month, the average drop in LDL cholesterol was a whopping 29 percent. “That’s a decrease similar to what you’d get from a daily dose of statins,” says Jenkins.

Jerry Richardson didn’t overhaul his diet as radically as did the volunteers in Jenkins’ study, though he did add more soluble fiber and healthy fats to his daily menu. After making these changes, along with taking supplements like guggulipid for about three months, his cholesterol fell precipitously, dropping from 280 to 185. His LDL went from 170 to 115.

“I’ve treated dozens of cases like this,” Sinatra says. “These people are proof that you really can lower cholesterol without drugs.”

Supplements That Don’t Live Up to the Hype

Garlic Garlic may be as good as ten mothers, but it won’t cut cholesterol. In an analysis of 13 of the best studies, researchers in the Department of Complementary Medicine at the University of Exeter in England found that while the savory bulb does reduce total cholesterol, the decrease is too modest to matter. The researchers aren’t dissing garlic entirely, however: They acknowledge that it has other heart-protective effects, such as lowering blood pressure.

Vitamin E A recent study in Circulation threw cold water on the notion that vitamin E is able to inhibit the harmful effects of LDL cholesterol. “The theory was that vitamin E was supposed to prevent thickening of the artery walls by preventing oxidation of LDL cholesterol, but that doesn’t appear to be the case,” says study author Howard Hodis, director of the Atherosclerosis Research Unit at the University of Southern California School of Medicine. The research showed that people with high LDL levels who took 400 mg of vitamin E a day for three years had the same rate of arterial wall thickening as those who didn’t take it.