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Elevated Cholesterol 3: What foods and nutrients are good for

healthy cholesterol levels?

This section contains an overview of some of the most
important foods and nutrients that can help promote healthy
cholesterol levels, please see the section Recent Research
Studies Confirm the Importance of Eating Healthy Foods on
Healthy Cholesterol Levels.
Foods for Healthy Cholesterol Levels
Whole grains,
oat bran, barley, Lowers LDL and
Soluble fiber*
peas, beans (all improves ratio of LDL
types, especially to HDL
soy), nuts
Helps decrease the
Salmon, tuna,
body's production and
Niacin* (if LDL
chicken, calf
increase its
levels are already
liver, halibut,
elimination of
high, supplements
cholesterol, prevents
may be necessary to
oxidation of LDL and
reduce levels)
can increase levels of
HDL cholesterol
Swiss chard,
sunflower seeds,
Helps prevent prevent
spinach, kale,
Vitamin E*
the oxidation of LDL
mustard greens,
Vitamin C*
Citrus fruits,
Helps prevent the

broccoli, red bell

peppers, kale,
Brussels sprouts,
Citrus fruits,
including naringenin
Carrots, sweet
Beta carotene*
potatoes, winter
squash, kale

olive oil

oxidation of

Lowers LDL and

Helps prevent the
oxidation of LDL
Help prevent
oxidation of
cholesterol and
increase levels of
HDL cholesterol

Help lower cholesterol
sunflower seeds
Lowers LDL
Brown rice
Lowers LDL,
Probiotic bacteria
increases HDL
Foods rich in taurine and omega 3 fatty acids (e.g., cold water
fish), monounsaturated fats (e.g.,
olive oil
, avocado, walnuts, almonds) and the allium family of
vegetables (e.g., garlic, onions) can also be helpful. These
foods' cholesterol-lowering benefits are discussed below under
"How Foods Help Lower Cholesterol".
Soluble Fiber:

Soluble fiber significantly reduces blood cholesterol levels by

several different mechanisms:

Decreasing the absorption of dietary cholesterol

Increasing the removal of bile
Increasing the breakdown of blood cholesterol to produce
more bile
Decreasing the activity HMG Co-A reductase, a key
enzyme involved in the production of cholesterol by the

First, soluble fiber in the intestines binds to bile from the liver,
so the bile is carried out of the body as waste instead of being
reabsorbed. In order for the body to make more bile, which is
necessary for digestion, it must break down more cholesterol,
removing it from the bloodstream. In addition, because bile is
needed for the absorption of cholesterol from food, binding
the bile makes it less able to assist in cholesterol absorption,
so less dietary cholesterol is absorbed from food as well.
Secondly, when normal levels of bacteria are present in the
colon, they are able to break down some of the soluble fiber
into what are called short-chain fatty acids. In addition to
being the preferred fuel of colon cells and thus essential for
good colon and digestive health, some short-chain fatty acids
are absorbed into the bloodstream, where they travel to the
liver and decrease the action of HMG Co-A reductase, one of
the main enzymes involved in the production of cholesterol.
Diets high in soluble fiber have been shown in some studies to
lower total cholesterol and LDL cholesterol as much as 2030%. The soluble fiber used in these studies was the naturallyoccurring fiber found in oat bran, beans, and other food
sources. In these same studies, the use of cooked soy beans, a
rich source of both soy protein and naturally occurring soluble

fiber, led to a decrease in total cholesterol of 30% and a

decrease in LDL cholesterol of 35-40%.
(For more information, see below: Research Studies Confirm
the Importance of Eating Healthy Foods on Healthy
Cholesterol Levels.)
Cultures in which soy foods constitute a major portion of the
diet typically have much lower rates of heart disease than
cultures with a low consumption of soy. In addition to this
epidemiological data, clinical studies have shown that soy
foods are protective against the development of heart disease
and its associated mortality. The beneficial effects found in
these studies are due to an intake of whole soy foods and not
the isolated soy components that are currently available in
supplement form.
Soybeans and foods made from them have been found to
significantly decrease the risk of heart disease and heart attack
via several mechanisms. Soy can help prevent the oxidation of
LDL cholesterol and soy foods have been shown to decrease
LDL by 35-40% and total cholesterol levels by 30%, to
decrease triglyceride levels, and to decrease platelet
aggregation reducing the risk of blood clots. Soy foods may
also increase levels of HDL (beneficial) cholesterol.
Research presented at the 2004 annual meeting of the North
American Menopause Society held October 6-9, 2004 in
Washington, D.C., and a study published in the November
2004 issuye of the American Journal of Clinical Nutrition
suggest that soy offers special cholesterol-lowering benefits
for premenopausal women: the isoflavones in soy appear to
work with a woman's own estrogen to decrease cholesterol
and increase bone mass. For a summary of this research, see

below: Research Studies Confirm the Importance of eating

Healthy Foods on Healthy Cholesterol Levels.)
For more information about soy, click Soybeans.; on fiber,
click Dietary Fiber.
Niacin, also known as vitamin B3, has been shown to decrease
the activity of HMG Co-A reductase, a primary rate-limiting
enzyme involved in the production of cholesterol, thus causing
a decrease in the body s production of cholesterol. Niacin
also helps increase the breakdown of cholesterol to bile,
decreases the proliferation of smooth muscle cells, helps to
prevent LDL oxidation, reduces platelet clumping, lowers
lipoprotein(a) levels, and can increase levels of HDL by as
much as 15-40%. Increasing HDL levels, particularly through
diet, can significantly decrease atherosclerosis progression.
Niacin has been shown to decrease cholesterol levels by 1026% and to decrease heart attack recurrence by 29%. Niacin
given to patients after a heart attack reduced non-fatal heart
attack recurrence by 27% and decreased long-term overall
mortality by 11%.
For more information, click Niacin.
Vitamin E:
Vitamin E prevents oxidation of LDL cholesterol, prevents the
growth of blood vessel plaques, and has been shown to reduce
the risk of heart attack and deaths related to heart disease.
The primary fat-soluble antioxidant in the body, Vitamin E is
the antioxidant found in highest quantities in LDL cholesterol
particles, which it protects from oxidation. As the main

antioxidant defender of lipids (fats) in the body, Vitamin E is

responsible for putting a halt to chain reactions of lipid
peroxidation anywhere in the body.
Vitamin E has also been shown to decrease platelet clumping,
prevent the rupture of existing atheromas, decrease the
migration of macrophages to atheromas, prevent the inhibition
of nitric oxide production, and to decrease the expression of
adhesion molecules on the surfaces of endothelial cells (which
form the outermost layer of blood vessel walls), thereby
reducing the amount of binding that can occur with monocytes
and other immune cells.
(For more information, see below: Research Studies Confirm
the Importance of Eating Healthy Foods on Healthy
Cholesterol Levels.)
Why whole foods are better than vitamin E supplements:
The potential downside of taking vitamin E as a supplement is
that large amounts have been associated with a possible
increase in oxidation. This is because, in order to prevent the
oxidation of fats, the vitamin E itself must become oxidized. If
all of the vitamin E in an LDL particle becomes oxidized, it is
then able to cause oxidation of the LDL cholesterol. A way to
prevent this from happening is to make sure that enough of the
antioxidant vitamin C is available. Vitamin C is very effective
at restoring oxidized vitamin E back to its non-oxidized,
antioxidant form. For this reason, studies recommend that an
increase in vitamin E intake be accompanied by an increase in
vitamin C intake.
One more caution for those interested in taking supplemental
vitamin E. Because of its ability to decrease platelet clumping
and clot formation, supplemental vitamin E should not be used

by those taking blood thinners unless they are being closely

monitored by their doctor. Getting your vitamin E from foods,
however, is highly unlikely to cause such problems. Just
remember to include foods rich in vitamin C (discussed next)
in your meals as well.
Vitamin C:
The body's primary water-soluble antioxidant, vitamin C is
needed for the proper function of blood vessels, regenerates
vitamin E, and can help decrease cholesterol levels through
several mechanisms. Although vitamin C is not found in LDL
cholesterol particles because it is not fat-soluble, it does play a
large role in the prevention of LDL oxidation. In addition to
restoring antioxidant function to vitamin E, vitamin C also
eliminates many free radicals produced by normal body
metabolism, thus preventing them from damaging cholesterol.
Low levels of vitamin C have also been associated with higher
levels of total cholesterol and LDL cholesterol, and lower
levels of HDL cholesterol. Vitamin C is required for the
breakdown of cholesterol to bile in the liver and also for the
uptake of LDL cholesterol into cells for normal use. Vitamin
C use is therefore associated with a decrease in total and LDL
cholesterol levels as well as an increase in HDL levels. These
effects seem to be most pronounced in men and tend to take
about six months of increased vitamin C intake to be
Low vitamin C levels are associated with an increase in
cholesterol deposition in the aorta, the main artery leaving the
heart. Vitamin C has been shown to decrease the binding of
monocytes to atheroma lesions, thereby reducing the rate of
atheroma growth. It is especially beneficial in preventing the
negative effects of smoking on the blood vessels and heart.

Vitamin C also reduces the deactivation of nitric oxide (a

chemical messenger that tells blood vessels to dilate) and
actually increases its production, leading to decreased vessel
spasm and increased vasodilation.
For more information, click Vitamin C and see below,
Research Studies Confirm the Importance of Eating Healthy
Foods on Healthy Cholesterol Levels.)
Beta Carotene:
Beta-carotene is another antioxidant found in foods. Although
it is not found in high quantities in LDL cholesterol particles,
it has been shown to prevent the oxidation of LDL cholesterol.
Beta-carotene, like vitamin C, is also able to increase vessel
dilation and reduce vessel spasm. One study has shown that
patients with the lowest level of beta-carotene intake had
almost twice the risk of having a heart attack compared to
those with the highest intake. The group of patients taking the
highest intake of beta-carotene had about 1/3 the risk of fatal
heart attack and about 1/2 the risk of cardiovascular death as
those in the group with the lowest intake.
For more information, click beta-carotene and see below LDL
Cholesterol Protected by Beta-Carotene.)
Fish are the best sources of taurine. Cold-water fish such as
salmon and cod are recommended as these are also rich in
beneficial omega-3 essential fatty acids.
Taurine is an amino acid component of protein particularly
common in fish protein. It has been shown to decrease
elevated cholesterol levels by decreasing the absorption of
cholesterol in the intestines in addition to increasing the

conversion of cholesterol into bile, thereby removing it from

the body. Studies have shown that individuals with higher
intakes of taurine have a lower risk of death from ischemic
heart disease. To gain the maximum protective benefit, eat a
serving of fish at least 5 days a week. For more information
about fish, serving ideas and recipes, click cod, halibut,
salmon, scallops, shrimp, snapper, yellowfin tuna
Foods Rich in Omega-3 Fatty Acids
Best Food Sources of Omega-3 Fats: cold-water fish such as
salmon and cod and their oils, flaxseed and its oil, walnuts,
and purslane.
Frequent consumption of fish, especially cold water fish since
these contain the most omega-3s, is associated with a
decreased risk of heart attack. A high intake of omega-3 fats,
when part of a diet low in saturated fat, has also been found to
help decrease cholesterol. Foods rich in omega-3s should be
used to replace foods high in saturated fats such as meat and
dairy products.
Monounsaturated Fats:
Best Food Sources of Monounsaturated Fats include: olive oil,
high oleic sunflower oil, avocado, almonds, cashews, peanuts,
sesame seeds, pumpkin seeds and walnuts.
Monounsaturated fats are a unique type of fat found in
particularly high quantities in olive oil. These stable fats
decrease the oxidation of LDL cholesterol, help reduce
cholesterol levels, and may partly explain why the
Mediterranean Diet, which is high in monounsaturated fats
as well as whole foods, is protective against heart disease.

Studies have revealed that populations that follow the

Mediterranean diet, which is high in vegetables and whole
grains, and low in saturated fats, but relatively high in total fat
due to a high intake of olive oil, tend to have fairly low rates
of cardiovascular disease and its associated mortality. Based
on studies of fat intake and heart disease in many countries, it
would be expected that these populations would have high
rates of heart disease because of the level of fat in their diets.
However, the opposite is true.
Recent studies have shown that LDL cholesterol particles that
contain monounsaturated fats, such as from olive oil, are much
more resistant to oxidation that those that contain high levels
of polyunsaturated fats, such as from other vegetable oils like
corn or safflower oil. In addition, the substitution of
monounsaturated fats for saturated fats in the diet has been
shown to decrease total cholesterol by 13.4% and to decrease
LDL cholesterol by 18%.
The most important aspect of the use of monounsaturated fats
is that they be used in place of saturated fats. Adding olive oil
to a diet that is already high in saturated and/or trans fats can
have negative effects on heart disease progression and risk.
Olive oil should instead be used to replace animal sources of
fat and other vegetable oils. Even though olive oil is a
relatively stable fat, it is important not to use olive oil when
cooking foods as high temperatures. Exposing even this more
stable oil to high temperatures may cause it to oxidize.
Instead, use our Healthy Saut or Healthy Stir Fry to cook the
food, then after removing it from the heat, add the olive oil.
You'll add all its delicious flavor and health-giving benefits to
your food, without potentially adding damaged fats that might

cause damage to the fats, including cholesterol, in your own

Polyphenols, including Pterostilbene
Pterostilbene, a powerful antioxidant compound found in
cranberries, grapes and blueberries, activates a type of cell
receptor involved in absorbing lipids, including cholesterol,
into cells for use in energy production. A study published in
the July 2004 issue of the Journal of Agricultural and Food
Chemistry found that pterostilbene was as effective as the
lipid-lowering drug ciprofibrate in activating this cell receptor,
called PPAR-alpha. (For more on this research see below:
Research Studies Confirm the Importance of Eating Healthy
Foods on Healthy Cholesterol Levels.
Olive Oil Polyphenols Primarily Responsible for Olive Oil's
Cardiovascular Benefits
Researchers now believe the abundance of polyphenols in
extra virgin olive oil, rather than its monounsaturated fatty
acids, are largely responsible for the oil's well known
cardiovascular benefits.
And its rich supply of polyphenols, which are known to have
anti-inflammatory, antioxidant and anticoagulant actions, may
also be central to emerging evidence that olive oil's protective
effects extend to colon cancer and osteoporosis.
Research conducted by Dr. Juan Reno and colleagues at the
Reina Sofia University Hospital, Cordoba, Spain, and
published in the November 2005 issue of the Journal of the
American College of Cardiology, investigated the effects of
virgin olive oil on endothelial function in 21 volunteers with
high cholesterol levels.

The endothelium, although just a one-cell thick layer of flat

cells that lines the inner wall of all blood vessels, may be the
critical player in cardiovascular health. Among its many
functions, the endothelium orchestrates the mechanics of
blood flow, and regulates blood clot formation and the
adhesion of immune cells to the blood vessel wall (one of the
first steps in the formation of plaque).
Normally, after a meal, endothelial function is impaired for
several hours. Blood vessels become less elastic, and blood
levels of free radicals potentially harmful to cholesterol
(lipoperoxides and 8-epi prostaglandin-F2) rise.
But when the subjects in this study ate a breakfast containing
virgin olive oil with its normal high phenolic content (400
ppm), their endothelial function actually improved, blood
levels of nitric oxide (a blood vessel-relaxing compound
produced by the endothelium) increased significantly, and far
fewer free radicals were present than would normally be seen
after a meal.
When they ate the same breakfast containing the same type of
virgin olive oil with its phenolic content reduced to 80 ppm,
the beneficial effects were virtually absent, and concentrations
of cholesterol-damaging free radicals increased. The results of
this study underscore the importance of knowing how to
select, store and serve your olive oil to maximize its
polyphenol content. For all the information you need, see our
How to Select and Store section in Olive oil.
Phytosterols are compounds found in plants that have a
chemical structure very similar to cholesterol, and when
present in the diet in sufficient amounts, are believed to reduce

blood levels of cholesterol, enhance the immune response and

decrease risk of certain cancers.
Phytosterols beneficial effects are so dramatic that they have
been extracted from soybean, corn, and pine tree oil and added
to processed foods, such as "butter"-replacement spreads,
which are then touted as cholesterol-lowering "foods." But
why settle for an imitation "butter" when these spreads contain
hydrogenated fat (see "A word of caution about plant-sterol
enriched margarines" above) and Mother Nature's nuts and
seeds are a naturally rich source of hydrogenated fat-free
phytosterols-plus cardio-protective fiber, minerals and healthy
fats as well?
In a study in the November 2005 issue of the Journal of
Agricultural and Food Chemistry, researchers published the
amounts of phytosterols present in nuts and seeds commonly
eaten in the United States.
Sesame seeds had the highest total phytosterol content (400413 mg per 100 grams), and English walnuts and Brazil nuts
the lowest (113 mg/100grams and 95 mg/100 grams). (100
grams is equivalent to 3.5 ounces.) Of the nuts and seeds
typically consumed as snack foods, pistachios and sunflower
seeds were richest in phytosterols (270-289 mg/100 g),
followed by pumpkin seeds (265 mg/100 g).
Allium Family Vegetables:
Best Sources of Allium Vegetable Compounds: Fresh, raw
garlic and onions contain the highest amounts of these
beneficial compounds.
Allium family vegetables contain compounds that have been
shown to modestly lower total cholesterol levels, lower blood

pressure in cases of hypertension, and slow the rate of plaque

growth. One of these compounds, S-propyl cysteine, has been
shown to decrease the liver cells secretion of apolipoprotein
B100 (apo B-100). Apo B 100 is virtually the only protein
component of LDL, which is composed of both protein and
cholesterol. Apo B-100 is that portion of the LDL molecule
that allows it to bind to receptors on other molecules, such as
those that make up the lining of the blood vessels. Having a
high level of apo B-100 in the blood is therefore a potent risk
factor for developing cardiovascular disease.
Other S-Alk(en)yl cysteines found in garlic have been shown
to inhibit cholesterol synthesis by lowering the activity of
HMG-CoA reductase 30-40%. Garlic incorporated into high
fat diets in animal studies has significantly decreased lipid
peroxidation (damage to fats such as cholesterol) and the
activity of a number of enzymes involved in cholesterol
synthesis including HMG CoA reductase.
In a randomized, double-blind, placebo-controlled study
involving men with high cholesterol, total cholesterol was
lowered 7% and LDL cholesterol 10% among those given
aged garlic extract, and in animals receiving garlic, blood
levels of total cholesterol and triglycerides dropped by 15 and
30% respectively. In later test tube studies using cultured rat
liver cells, garlic, specifically its water-soluble sulfur
compounds, was found to inhibit cholesterol synthesis 4487%. Of all these compounds, S-allylcysteine, was the most
potent inhibitor of cholesterol synthesis. In other test tube
studies, evidence has been presented that shows several garlic
compounds can effectively suppress the oxidation of LDL, and
in human subjects, short-term supplementation of garlic has
been shown to increase their LDL's resistance to oxidation.

Yogurt Lowers LDL, Raises HDL Cholesterol

Daily consumption of 3 ounces (100 g) of probiotic yogurt
(yogurt containing health-promoting bacteria) significantly
improved the cholesterol profile, lowering LDL (bad)
cholesterol while raising HDL (good) cholesterol, in women
In this study, (Fabian E, Annals of Nutrition & Metabolism),
one group of 17 women consumed 3 ounces (100 g) a day of
probiotic yogurt, while a second group of 16 women were
given 3 ounces of conventional yogurt daily for 2 weeks. Then
both groups were given 6 ounces (200 g) of the type of yogurt
they had been consuming for 2 more weeks. The study ended
with a final 2 weeks during which both groups of women ate
no yogurt.
In the women consuming probiotic yogurt, not only did levels
of LDL (bad) cholesterol decrease significantly, but their HDL
(good) cholesterol substantially increased. Women consuming
conventional yogurt also experienced a significant drop in
LDL cholesterol, although their HDL did not rise.
The take-home message: adding a daily cup of yogurtpreferably a yogurt with probiotic bacteria-to your healthy
way of eating is an easy and delicious way to improve your
cholesterol profile.
Here are just a few ways to enjoy yogurt:

Top your daily cup of yogurt with a quarter-cup of

granola, a handful of nuts, and some frozen berries or
dried fruit for a quick, delicious and sustaining breakfast.

Creamy yogurt, chives, and freshly ground sea salt and

pepper make a great topping for baked potatoes, yams or
other cooked vegetables.
For a creamy salad dressing or vegetable dip, just mix a
cup of yogurt with a quarter cup of extra virgin olive oil
and your favorite herbs and spices.

For more information on cholesterol see:

Elevated Cholesterol 1 - If I have high cholesterol levels,

can a healthy way of eating help me lower them into a
normal range?
Elevated Cholesterol 2 - What is high cholesterol and
what levels of LDL and HDL are considered healthy?
Elevated Cholesterol 4 - What foods should I consume
sparingly or avoid to promote healthy cholesterol levels?
Elevated Cholesterol 5 - Recent research studies confirm
the importance of eating healthy foods on healthy
cholesterol levels