It’s no secret that one of my main passions in life is
preventing disease through natural management of cholesterol and blood
pressure. Nerdy I may be, but I’ve written in the past about how to interpret
your cholesterol labs and how to lower your blood pressure through diet and exercise, and will continue to do so in the future. The evidence is clear that
eating a healthy diet and pursuing a healthy lifestyle works not only to
prevent but also treat high blood pressure and high cholesterol, so it’s
probably about time that I devoted a weekly blog to the cholesterol side of the
story. (If at any point you need a refresher, here’s an explanation of LDL, HDL, Cholesterol and all the rest.)
The ATP III was published by the NIH in 2004 to be a guide
for clinicians to diagnose, evaluate and treat high cholesterol in adults. Like
the JNC 7, which I blogged about a few months ago, the proposed guidelines
include recommendations for treatment using diet, lifestyle, and
pharmaceuticals. While the ATP III focuses heavily on pharmaceuticals, it makes
strong recommendations for lifestyle changes, or as it refers to them, TLC
(Therapeutic Lifestyle Changes). Unsurprisingly, these lifestyle
recommendations look remarkably similar to the ones suggested to lower blood
pressure.
Eat less saturated fat.
There’s a longstanding rumor out there that cholesterol in foods causes high
blood levels of cholesterol, a rumor that lays a lot of blame on eggs in
particular. The truth of the matter is that saturated fat plays a much more
important role in causing high cholesterol, as it stimulates the body to raise
blood levels of cholesterol, especially LDL (“bad cholesterol”). As a result,
it’s much more important to avoid saturated fat than cholesterol in your diet.
To help decrease your cholesterol levels and prevent future
disease, the ATP III recommends that fewer than 7% of your calories for the day
come from saturated fat. As a practicing physician, I know that this number
means very little to most people, and even I can’t tell you what percentage of
my daily calories come from saturated fat, so here are clearer instructions.
Most if not all saturated fat comes from animal sources, like milk and meat, so
to limit your saturated fat, limit your intake of animal-source foods, and
choose low fat options, like fish, lean poultry or game. Also note that
individual people vary in their individual dietary needs, so discussing your
diet with a doctor or other healthcare professional can help you to assess your
current situation, set goals for the future, and work out a plan for getting
there.
Get more fiber in your diet. When I was in naturopathic school, we had to learn the details of the
many ways that dietary fiber reduces cholesterol, an activity that many of my
colleagues worked into mnemonics, songs, and other memory aids. I don’t have
any songs to share with you, but I can tell you the most important part of the
story – dietary fiber helps the body rid itself of excess cholesterol.
Without going into all of the gory details, here’s how it
works: The body releases cholesterol into the digestive system every day as
part of the digestive process. When there is fiber present in the digestive
tract, it picks up that cholesterol and carries it out of the body as part of
normal elimination. If there is not adequate fiber in the digestive tract,
however, it is reabsorbed into the blood stream and continues to circulate,
thus keeping cholesterol levels high. Here too, we have some numbers from the
ATP III, which recommends 10-25 grams of fiber a day. While this can be a
little easier to figure out, I always find that making recommendations about
the food you eat is more helpful than number crunching. Fiber primarily comes
from fruit, vegetables, legumes and grains, so boosting these will boost your
fiber intake. While all of these plant-based foods are good sources of fiber, I
especially recommend beans, lentils, and other legumes, as their fiber content
far outpaces that of even high-fiber veggies like cabbage and broccoli.
Get regular exercise.
Regular exercise helps with a number of things, including weight loss, stress
management, blood pressure and cancer prevention, so it’s no shock that it
helps with cholesterol too. Importantly, regular exercise not only lowers LDL
(“bad cholesterol”), it raises HDL (“good cholesterol”). While the exact
mechanism by which this occurs is not fully understood, it is currently
believed that at least part of the action is by encouraging the LDL cholesterol
to be taken out of circulation by the liver, and put into the digestive tract
for elimination. The ability to raise HDL is very important, as there are no
drugs currently available that raise HDL, and HDL exerts a strongly protective
action on the cardiovascular system. For further reading on what ‘counts’ as
exercise, and how much to get, read this blog which I wrote a few months ago.
The most important thing about exercise is to get out there and start moving –
many Americans lead very sedentary lives, and it’s important to note that even
some exercise is better than none.
Watch your weight.
If you follow the above recommendations, it should help you lose weight. That
said, weight loss is a challenge to most people who attempt it. Because the
benefits of maintaining a healthy weight are so great (including lowering blood
cholesterol levels), it’s important to commit to weight loss, and for most
people, that means getting some assistance from a healthcare professional,
personal trainer, or other provider. Weight loss, even when it proceeds
steadily, rarely happens quickly, and so it’s important to build a therapeutic
alliance in order to help you stay committed and persevere through the
inevitable challenges.
Let me close by saying that, naturopathic physician or not,
I believe that medications are sometimes necessary to help reduce the risk of
future disease. However, medications are never the only answer. Some people are
able to bring their cholesterol into a healthy range through diet and exercise
alone, some through diet and supplements, some through a combination of diet,
exercise and medications. In my practice, I find that many people are able to
limit the number and dose of medications they require through diet and
exercise. Not only is this a more sustainable and effective treatment, but
being able to take control of one’s health also empowers people in a way that
medications cannot, and will never be able to.
