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Rodale
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TODAY
updated 4/18/2007 12:27:59 PM ET 2007-04-18T16:27:59

I often tell my clients to take nutritional changes at a pace that feels comfortable to them. That’s not good enough when it comes to cardiovascular disease. The consequences of doing too little are severe — heart attack, stroke, or even worse. Sadly, not everyone gets a second chance. So please don’t wait until after the next vacation, or your daughter’s wedding, or that anniversary dinner to start. My advice is to start immediately and go for broke! Change your diet, change your habits, change your lifestyle. 

Cholesterol 101
Cholesterol is a natural fat-like substance found in all animal tissue — humans included—because it is part of all cell membranes. Cholesterol is also part of the myelin sheath that surrounds and protects nerves, and it is used to make vitamin D, bile, and some hormones. Our bodies make all the cholesterol we need for good health, so extra cholesterol coming from a poor diet provides NO benefit (in fact, quite the contrary — it clogs our arteries).

Cholesterol comes in two main varieties: low-density lipoprotein (LDL) cholesterol (commonly called “bad cholesterol” — remember L for LOUSY), and high-density lipoprotein (HDL) cholesterol (“good cholesterol” — remember H for HERO). LDL cholesterol is one of the components of vessel-clogging plaque. Over time, plaque can incorporate calcium and other substances that make the plaque hard and brittle. If the plaque deposits grow large enough, they can block a blood vessel. In addition, the brittle plaque can break off, travel through the blood stream, and form a clot anywhere in the body.

LDL-Cholesterol
The higher your LDL cholesterol, the greater your risk of developing life-threatening plaque. So, you want your low-density low. According to the National Institutes of Health (NIH), the optimal level of LDL cholesterol is below 100 mg/dL. High LDL cholesterol is defined as 160 mg/dL and higher — but certainly anything above 130 is worth treating.

HDL-Cholesterol
HDL cholesterol, on the other hand, is like nature’s plaque vacuum cleaner — it picks up the vessel-clogging cholesterol and carries it away to the liver, where it is disposed of in the form of bile. The higher your HDL levels, the cleaner your blood vessels will be. So, you want your high-density high. According to the NIH, people with HDL of 60 mg/dL or higher have a lower risk of heart disease … whereas HDL below 40 mg/dL is considered too low.

Cholesterol Ratio
Because HDL is so important to the health of blood vessels, some physicians prefer to talk about the cholesterol ratio — your total cholesterol divided by your HDL cholesterol. For example, if your total cholesterol number is 250 and your HDL is 50, your ratio is 250/50 or 5. A ratio of 3.5 is considered optimal, and people are urged to aim for a ratio of 5 or less.

High cholesterol can be caused by several factors, some you can change, and some you can’t. Heredity can play a big part. Some people can have a perfect heart-healthy lifestyle, and still have skyrocketing cholesterol because their bodies naturally make too much of it — our bodies’ production of cholesterol is independent from what we eat. Also, LDL cholesterol increases naturally with age, so even if you put up all-star numbers when you were younger, each passing year has made you that much more likely to have problems.

High LDL cholesterol (the “lousy” type) leads to atherosclerosis …which causes narrowing of the blood vessels…which means your heart has to pump that much harder to squeeze blood through them…which means increased blood pressure and other life threatening concerns. You can improve your cholesterol profile by reducing body weight (if you are overweight), increasing physical activity, and following my cholesterol-busting nutrition program.

Lowering cholesterol through Diet!
Right off the bat, I tell you this: If you are overweight, focus on losing weight. Research has shown that losing just 10 pounds can reduce LDL cholesterol by 5 to 8 percent. Become more physically active. Even moderate exercise can help improve your cholesterol, as well as triglycerides, and blood pressure.

Specific foods to limit or avoid:
The top dietary recommendations for lowering cholesterol are to eliminate or at least drastically limit the foods you eat that contain saturated fats, trans fats, dietary cholesterol, and refined carbohydrates.

  • Saturated fats: They are found in animal-based foods, including meats, butter, whole-milk dairy products (including yogurt, cheese, and ice cream), and poultry skin. They are also found in some high-fat plant foods, including palm oil. The Nurses’ Health Study, which included more than 80,000 participants, showed that saturated fats increase the risk of coronary artery disease. Numerous studies have shown that by replacing saturated fat with olive oil or nuts (monounsaturated fat)… you can reduce LDL-cholesterol by significant amounts.

  • Trans fats: They were developed in a laboratory to improve the shelf life of processed foods —and they do. But calorie for calorie, trans fats are even more dangerous than the saturated fats. Most stick margarines contain trans fats, and trans fats are found in many packaged baked goods, potato chips, snack foods, fried foods, and fast food that use or create “hydrogenated oils”. (All food labels must now list the amount of trans fats, right after the amount of saturated fats – good news for consumers.) By substituting olive oil or vegetable oil for trans fats in just 2 percent of your daily calories, you can reduce your risk of heart disease by 53 percent. In a 2000 calorie-a-day diet, that’s about 40 calories. Think of it this way — an average serving of French fries contains about 5 grams of trans fats, or about 45 calories worth of evil trans fats, and a daily serving would be enough to double your risk of heart disease. There is no safe amount of trans fats, so try to keep them as far from your plate as possible. 

  • Cholesterol-rich foods: Years ago, doctors used to recommend that people with heart disease avoid all high-cholesterol foods. But dietary cholesterol does not harm health as much as saturated fats and trans fats do. Research into the effects of dietary cholesterol have been mixed, which is not surprising — different people have different susceptibilities. Still, if you want to take a firm hand to reduce your risk factors, you may want to consider cutting down on all high-cholesterol foods, including egg yolks, shellfish, liver, and other organ meats like sweetbreads and foie gras.

Good foods to choose:

  • Soluble fiber: This may help reduce cholesterol by grabbing onto cholesterol and escorting it through your digestive system and out of your body. It also may reduce the intestinal absorption of cholesterol as well. Research has shown that eating an additional 5 to 10 grams of soluble fiber a day can reduce LDL cholesterol by 3 to 5 percent. If you eat a few foods rich in soluble fiber every day, you’ll get at least 5 grams. It is a small improvement, but every percentage point counts! Some of the best soluble fiber rich foods include; oatmeal, barley, lentils, Brussels sprouts, peas, beans (kidney, lima, black, navy, pinto), apple, blackberries, pears, raisins, oranges, grapefruit, dates, figs, prunes, apricots, broccoli, and sweet potato.

  • Omega-3 fats and monounsaturated fats: There was a time when heart researchers slapped the same label — “bad” — on every kind of fat. Now, we know that trans fats and saturated fats are amazingly dangerous for cardiovascular health, but omega-3 fats and monounsaturated fats are actually good for your heart.

    Heart-healthy fish oils are especially rich in omega-3 fatty acids. In multiple studies over the past 15 years, people who ate diets high in omega-3s had 30 to 40 percent reductions in heart disease, and fewer cases of sudden death from arrhythmia. Although we don’t yet know why fish oil works so well, there are several possibilities. Omega-3s seem to reduce inflammation, reduce high blood pressure, decrease triglycerides, help to make blood thinner and less sticky so it is less likely to clot … PLUS raise HDL cholesterol!  So omega-3s affect nearly every risk factor for heart disease.  I recommend eating at least three servings (4-ounce portions) of one of the omega-3-rich fish every week — fish like wild salmon, sardines, anchovies and mackerel (not king). If you cannot manage to eat that much fatty fish, incorporate omega 3 fortified eggs and additional plant based sources like walnuts, soybeans and ground flax. Also, consider taking fish oil capsules.

    Scientists discovered the benefits of monounsaturated fats, mainly found in olive oil by observing Mediterranean populations. They use olive oil more than any other form of fat and typically have low rates of coronary artery disease. Research shows it doesn’t help to just add monounsaturated fats to your diet — you need to replace some of the unhealthy fats that are already in your diet (all those saturated and trans fats mentioned earlier) with better choices. There is evidence that substituting olive oil for saturated fat and low-quality refined carbohydrates can lower LDL-cholesterol and increase HDL-Cholesterol.

    Best foods for monounsaturated fats include: Olive oil and olives, canola oil, avocado, macadamia nuts, hazelnuts, pecans, almonds, peanuts, cashews, pistachio nuts and peanut butter.

  • Plant sterols or stanols: These are natural substances found in small amounts in the cell membrane of plants, including fruits, vegetables, legumes, nuts, and seeds. Sterols are found in relatively high amounts in pistachio nuts, sunflower seeds, sesame seeds, and wheat germ. In terms of their effects in the human body, plant sterols and stanols are virtually the same.

    Sterols and stanols have a structure similar to cholesterol, and they compete with cholesterol for access to receptors in the small intestines. Imagine 15 people all hoping to get a ride in their friend’s Volkswagen Beetle — not everyone is going to be riding in the car. Sterols/stanols compete with cholesterol, effective blocking its access.  Research has shown that sterols and stanols have been shown to cut the amount of cholesterol absorbed by the small intestines by about 50 percent, and to reduce LDL cholesterol levels by between 5 and 14 percent.

    You can reap these cardiovascular benefits with just 2 grams of sterol/stanol per day, though you can’t get that much eating fruits and vegetables alone. Sterols and stanols have been added to certain heart-healthy spreads that taste and cook just like margarine, including Take Control and Benecol spreads. These spreads have been found to be safe, with very few side effects (although some people complained of upset stomach). That said they’re only for those with cholesterol problems, who should consume no more than the amounts recommended: 2 to 3 tablespoons per day (each tablespoon provides one gram of sterol/stanol). You can use it on whole-grain bread, melt it on heart-healthy vegetables, or use it in cooking. I recommend trying the light versions of these spreads to save yourself 30 calories per tablespoon. If you’re not a bread eater, please don’t start just to have a vehicle for these spreads! Instead consider the plant stanol/sterol supplements.


    My favorite is Cholest-Off by Nature Made. You have to take two tablets in the morning and two tablets at night (a total of four tablets a day), 15 to 30 minutes before a meal. If you are taking a prescription cholesterol-lowering medication, talk with your doctor before taking sterol/stanol supplements.
  • Alcohol: The benefits of alcohol depend, in part, on exactly what your cardiovascular risk factors are. Research suggests that drinking moderate amounts of alcohol (that’s no more than one serving per day for women, and no more than two servings per day for men) may reduce the risk of coronary artery disease by about 25 percent, and reduces the risk of death from heart disease by about 12 percent. *Alcohol seems to increase the good HDL cholesterol and to prevent clots.

    Although all alcohol has heart-healthy benefits, red wine also contains antioxidants called flavonoids and resveratrol—an extra boost of nutrition.

    However, BIG CAVEAT: if your problem is high triglycerides, or you’re at high risk for breast cancer, alcohol is contraindicated and should be enjoyed as a very occasional treat. Also, if you are currently taking medication for lowering blood pressure or cholesterol, or if you have diabetes, ALWAYS talk with your doctor about whether drinking alcohol makes sense for you. There are some questions about whether alcohol might interact with medications, or complicate potential liver problems.

For more information on healthy eating, visit TODAY nutrition expert, Joy Bauer’s Web site atwww.joybauernutrition.com.


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