Eat your way to lower cholesterol

Q: I am 45 years old. My doctor tells me I have borderline high cholesterol, which both my parents had. He told me to watch my saturated-fat intake, which I am doing. Are there any other things I should change in my diet?

A: When you say high cholesterol, I am assuming you mean the total cholesterol. But remember that the total cholesterol can be high for a lot of reasons. It is important to look at the breakdown of each of the components — the LDL ("bad" cholesterol), HDL ("good" cholesterol) and triglycerides. This is because the approach can be slightly different depending on the exact numbers. That said, many people have a high total cholesterol because of a high LDL, so I am going to target my discussion to that issue.

Remember also that high cholesterol may be genetic, but that doesn't mean you can't make a difference with diet. Here are some of my thoughts:

Try eating more soluble fiber. There are two main types of fiber — soluble and insoluble. You can tell something has soluble fiber by the way it gets gooey, or gel-like, when it mixes with water. (Think of oatmeal, for instance.)

Soluble fiber lowers cholesterol because it mixes with fats in your gut and decreases their absorption. One peer-reviewed analysis suggests that every gram of soluble fiber helps drop LDL cholesterol by 2 mg/dl. The plateau point for this effect is still not clear. Good sources include oats, oat bran, flax seed, nuts, barley, beans and some fruits and vegetables.

One simple way to guarantee you get enough soluble fiber is to switch to oatmeal for breakfast in the morning. Another is to mix 1 tablespoon of psyllium husk (this is the type of soluble fiber found in Metamucil) with a glass of water once a day. If you want to do both, take the psyllium at a different time of the day to spread out the benefit. You can find plain psyllium husk, without added sugar or artificial flavoring, in a health-food store.

Keep in mind that when you increase the fiber in your diet, you may temporarily get some gas and bloating while your body adjusts. Remember to start low and go slowly. Also, although fiber will usually keep people regular, if you don't drink enough water, it can make you constipated.

Add plant sterols to your diet. Plant sterols are natural compounds that work by dropping the amount of cholesterol your body can absorb from your diet. They work best when they can mix with food.

Two good sources are Benecol or Take Control margarine, which you can find at a regular grocery store. Believe it or not, these products got FDA approval for their cholesterol-lowering effects. Although I usually don't recommend margarine because it can have trans fats (damaged fats that can raise cholesterol), these products are not really high in trans fats. The dose is usually 2 grams of plant sterols per day. It takes about two weeks to work, and you need to use it consistently. If you stop, your cholesterol will go back up.

If you are not into margarine, there are also "chews" available in all sorts of flavors. While perhaps not the holistic ideal, some people may like the idea of satisfying their sweet tooth while lowering their cholesterol. I don't usually recommend capsules because it takes longer to release the plant sterols into the gut, which may decrease their efficacy.

Eat nuts instead of meat. One study in a peer-reviewed journal found that people who ate nuts, such as almonds and walnuts, four times a week had fewer heart attacks than those who ate nuts less often than once a week. Almonds and walnuts have beneficial fats that help lower cholesterol, and they are high in protein, fiber and vitamin E. Raw nuts are probably ideal, because the roasted varieties are often high in salt.

Combine these elements. This may be more helpful than doing one alone. By itself, fiber lowers cholesterol, but its effects don't come anywhere close to the most commonly used cholesterol-lowering drugs, the statins. Same thing goes for nuts and plant sterols — in addition to other possible contenders, like soy.

But one study, published in the Journal of the American Medical Association, suggests that when you combine the effects of soy, soluble fiber, almonds and plant sterols in sufficient amounts, the effect can be just as powerful as eating a low-fat diet and taking 20 mg of Lovastatin per day. This combination, known as the "portfolio eating plan," requires that you eat 30 grams of almonds, 20 grams of soluble fiber, 2 grams of plant sterols and 50 grams of soy protein per day. For more information, visit www.portfolioeatingplan.com.

Take medication. Statins or other cholesterol-lowering drugs may be necessary and important. Keep in mind that sometimes people need to use medication because their cholesterol is simply too high for diet or natural supplements to work completely. In this case, the goal of a natural approach is to help you use the least amount of medication necessary to do the trick. Statins may also have benefits outside of cholesterol lowering for certain issues, such as heart failure (when the heart muscle doesn't pump effectively).

Dr. Astrid Pujari is a Seattle M.D. with an additional degree as a medical herbalist; she practices at the Pujari Center and teaches as part of the residency programs at Virginia Mason and Swedish/Cherry Hill hospitals. Send questions to apujari@seattletimes.com for possible use in future columns. All information is intended for education and not a substitute for medical advice. Consult your doctor before following any suggestions given here.