Thursday, December 1, 2011

Lowering Your Cholesterol Through Diet and Lifestyle

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.