Your blood cholesterol level is determined by your genetic make-up (how much cholesterol your liver "is programmed" to manufacture daily) and by the amount of fat that you choose to consume in your diet. While you can't choose your parents you can of course control the dietary part of the equation. Choosing to eliminate some foods and then seeking out others can make a huge difference! By eliminating specific dietary fats your LDL ("bad") cholesterol can be reduced approximately 10%. This alone is worthwhile, but if you go further and add back to your diet soluble fiber, soy foods, nuts and seeds, and then incorporate into your diet phytosterols (in the form of a sterol margarine) you can decrease your cholesterol level by an additional 20%! This overall 30% reduction in LDL cholesterol is equivelent to beginning a "statin" cholesterol lowering medication. But, making dietary change can be difficult to accomplish. It means getting into a new habit of eating.
The decision as to whether you make small or major changes in your diet (or even begin taking medication) of course depends on how high your initial cholesterol level is and how aggressively you want to lower it. If one has known heart disease, diabetes, or multiple risk factors making heart disease more likely (high blood pressure, tobacco use, family history of concern) then one naturally targets her/his cholesterol much lower. The average individual's total cholesterol should be less than 200, triglyceride level less than 150, HDL ("good") cholesterol greater than 40, and LDL cholesterol less than 130. If one is at greater risk of heart disease (or simply wants to optimally prevent arterial disease) then you should target your LDL level below 100- and ideally to 70. Given these targets many people do need to begin medication to be successful. However, there are many people who can significantly lower their cholesterol level through diet alone. Dramatic improvement often means dramatic dietary change. First one needs to eliminate the very fats which push blood cholesterol upward, and then you can make great strides by seeking out specific cholesterol lowering foods.
The wonderful news is that the optimal diet for lowering blood cholesterol levels is really no different from the dietary pattern we have already reviewed! A plant-based diet is overall the most healthful whether we are discussing weight loss, cholesterol lowering, or simply promoting wellness. So what follows is a bit redundant, but we emphazise specific dietary components and how they impact cholesterol.
Foods to Avoid
First one needs to avoid the very foods that raise blood cholesterol. This is not an all or none deal- the more aggressively one reduces intake of these foods the greater the benefit. Ultimately one must choose how much dietary change she/he is willing to accept. The primary food components that one should reduce,or eliminate, include saturated fat, partially hydrogenated oils (trans-fatty acids), and cholesterol. All three of these fats play a harmful role. Thankfully it is not at all difficult or confusing to structure a diet which eliminates these fats. It is just a matter of deciding how far you want to stretch. In fact, this optimal diet is truly simple- if one's goal is to eliminate all cholesterol and nearly all saturated fat from the diet then just "eat nothing that had a mother". This may sound silly, but it is a nutritionally accurate and easily remembered. Cholesterol is found only in animal-based foods. Saturated fat is almost exclusively consumed through animal-based foods, with the exception of tropical vegetable oils (thick oils such as coconut, palm, and palm kernel). The third type of fat to avoid, partially hydrogenated oils, are primarily only found in man-made products- so beware of products in bags, cans, and boxes. That said, a whole foods, plant-based diet rich in fruits, vegetables, whole grains, nuts/seeds, and legumes ideally avoids all three of these harmful food components.
Of course few people will read this and suddenly decide that vegetarian (no meat, poultry, or fish) or vegan (vegetarian, plus no dairy products) eating is best for them. That is understandable. For the non-vegetarian who still also wants to aggressively lower their blood cholesterol we might recommend this compromise: Eliminate meat and pork from the diet (pork has the saturated fat content of red meat), eat small amounts of skinless poultry on occasion, increase your consumption of fish due to the lower saturated fat content of fish plus it's healthful omega-3 fatty acid content, eat primarily non-fat dairy products (skim milk, non-fat cottage cheese/yogurt) and enjoy a minimal amount of flavorable cheese. You can then eat freely from a whole foods, plant-based diet and very successfully restrict harmful fats. Additionally, it is imperative also to avoid partially hydrogenated oils as they are unique in raising LDL and lowering HDL cholesterol- nothing else can cause this harm! Be vigilant and slightly paranoid of any man-made food- for example most conveneince foods, fast food, and store bought chips/crackers/snacks are loaded with trans-fat. Make it a practice to read the ingredient list of anything you purchase- and boycott any food containing a partially hydrogenated oil of any type! This careful grocery shopping actually does not represent alot of work- people generally buy the same foods on each trip to the grocery store, and once you have "screened" them once for unwanted, unexpected trans-fat the job is done. Diane and I really only scrutinize food products we haven't tried, new things, etc. You will be surprised to find that many common and generally thought of as "healthful foods" are loaded with trans-fatty acids (low fat Triscuits, for example).
Foods to Seek Out
After one has eliminated harmful fats there is now more room on the plate for foods which will lower blood cholesterol further! In a sense these are "functional foods"- foods which you can enjoy normally, but also play a purposeful role by lowering cholesterol levels. The following four dietary additions can produce as much as a 20% drop in one's LDL cholesterol level.
- Add 3-6 grams per day of soluble fiber to the diet. Common sources include oats and oat bran(oatmeal and other cereals), psyllium seeds (used in Metamucil), ground flaxseeds, apples/berries/oranges, and kidney beans and other legumes. Soluble fiber can reduce one's LDL cholesterol by approximately 7%. We simply make eating these foods a regular, daily habit.
- Add soy foods to the diet. Sources include soy milk, tofu, tempeh, miso soup, soy nuts, edamame soybeans, and the huge array of soy burgers/chicken/meat look-a-likes. Soy foods appear to lower cardiovascular risk by decreasing LDL cholesterol and triglycerides, increasing HDL cholesterol, and by reducing cholesterol oxidation. Rather than "counting total dietary soy grams" one might just introduce more soy into the diet- often as a meat replacement- and experiment. Recent studies do show that a diet containing 45 grams of soy protein daily reduces LDL cholesterol by 12 %.
-Add nuts and seeds to the diet. Almonds lower LDL cholesterol and walnuts are an excellent source of omega-3 fatty acids. A recent study demonstrated that 10 grams of almonds daily lowered LDL cholesterol by 1-2%. That isn't much, but it is a great bonus for snacking! Nuts are a good source of monounsaturated fat. Add them to salads and bring them to work as healthful snacks, rather than the typical bagels/pastries/etc.
-Add a plant sterol margarine to the diet. Dietary studies have repeatedly demonstrated that plant sterol use lowers LDL cholesterol. Phytosterols are chemically very similar to animal/human cholesterol. When ingested the plant sterol competes with cholesterol for absorption through our intestine. The plant sterol essentially blocks cholesterol absorption. The sterol itself is harmless. Presently the only source of plant sterol in the United States is in margarine. Benacol and Take Control are the two margarines available in the grocery store. If one uses 2 grams of either of these margarines a day (ideally split into two "one gram servings") then LDL cholesterol is reduced 10%. One can use these margarines just like any other spread. They taste like any margarine. The trick is to use them regularly to gleam the benefit!