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Topic summary contributed by volunteer(s): Randy

A plant-based diet high in fiber appears to lower total cholesterol and specifically LDL (bad) cholesterol (see here, here, here, here, here, here, here, and here).

In accordance with the director of the Framingham Heart Study, the USDA Dietary Guidelines (see also here, here, here, here) recommend a more plant-based diet to lower cholesterol intake. Dr. Dean Ornish and the late Dr. Walter Kempner have promoted such diets for their health benefits. Unfortunately, many doctors may not be aware of this essential life-saving information (see also here and here), although that may be changing. A nutrition update for physicians published by Kaiser Permanente, the largest U.S. managed health care organization, has encouraged its doctors to recommend a plant-based diet to help patients lower their cholesterol. 

Cholesterol-lowering drugs, such as statins, may not only be far less effective than generally assumed (less than 5% effective over five years), but may have side effects such as increased breast cancer risk. Diet and/or lifestyle changes can be as effective as statins with positive side-effects.

75% of heart attack patients are in the “normal” cholesterol range (see also here, here). Data suggests that cholesterol levels can never be too low. The average U.S. blood cholesterol level is so high that a large part of the “normal population” is at a very high risk of coronary heart disease. In fact, aiming for “below average” cholesterol is one of seven goals set by the American Heart Association to reduce U.S. heart disease deaths. The safe level for total cholesterol is likely 150 or lower (see also here), and the optimal “bad cholesterol” LDL level to achieve to avoid heart attacks may be 50 to 70.

The American diet is so high in cholesterol-raising food components that even children as young as ten years old may show signs of atherosclerosis. There are rare genetic conditions that give people high cholesterol no matter what they eat, but such genetic defects occur in no more than 1 in 200 people. For most people, poor dietary choices seem to be the main culprit to their high cholesterol.

Why do we need to lower our cholesterol? High cholesterol levels can raise heart disease risk (see also here, here, and here), the number one cause of death in the U.S.  Our stomach may act as a bioreactor for the oxidation of high-fat, cholesterol-rich foods. When LDL cholesterol infiltrates the lining of an artery and gets oxidized, it triggers an inflammatory response, and can eventually block the artery. Inflammation of the aorta, our largest artery can lead to an abdominal aortic aneurism, which can mean an unexpected painful death. Plant phytonutrients and antioxidants found in abundance in plant foods including fruits and vegetables can help prevent cholesterol from oxidizing.

By preventing the buildup of cholesterol in our blood, we may be able to prevent atherosclerosis in our coronary arteries. Cholesterol crystallization may be what causes atherosclerotic plaque rupture, the trigger for heart attacks. Regardless of cholesterol size, LDL seems a risk factor for heart attacks.

In addition to heart disease, high cholesterol has been linked to risk for adverse skin effects, lower back pain (see also here), sexual dysfunction (see also here, here, here and here), periodontitis, gallstones, type 2 diabetes risk (see also here and here), Alzheimer’s disease (see also here), increased risk for breast cancer, declining kidney function, and DNA damage leading to faster biological aging.

A person trying to reduce cholesterol and bad cholesterol numbers should be cautious of consuming meat (see also here), dairy products, chicken, and eggs (see also here, here, here, here, here, here, and here). Surprising to many, switching from consuming beef to chicken and fish may not lower cholesterol. TMAO, which is produced in our guts when eating animal products, may increase the buildup of cholesterol in our arteries, and heme iron found in meat can contribute to atherosclerosis risk by oxidizing cholesterol.

Brains contain more cholesterol than any other food, though in terms of the American diet, eggs are the top source of cholesterol (see also here and here). Eggs have so much cholesterol, they are not able to be labeled “healthy” under FDA guidelines, as just half of an egg goes over the safety limit. The daily consumption of the cholesterol found in a single egg may cut a woman’s life short as much as smoking 25,000 cigarettes over 15 years.

Low carb diets seem to significantly raise LDL cholesterol levels, along with being overweight (see also here). For Americans, food prepared at home tends to have less cholesterol than food eaten at fast-food and sit-down restaurants. Eliminating saturated fat and dietary cholesterol can greatly lower cholesterol levels in the blood.

Coconut oil and non-filtered coffee (see also here) may also raise cholesterol levels, although olive oil and nut consumption does not seem to have an affect. While a possible cholesterol reducer, red yeast rice is not recommended as the lovastatin dosing in it is unreliable. 

Unlike animal foods, plant foods do not contain dietary cholesterol. Whole-based plant foods that have been linked to lower cholesterol include Ceylon cinnamon; kale; legumes, including beans (see also here) and soy; Amla or Indian gooseberries (see also here); apples and dried apples (see also here); nuts (see also here, here, and here) and seeds including sesame seeds, pistachio nuts, flaxseeds (see also here and here), specifically Brazil nuts, walnuts (see also here), and almonds; kiwis;  green tea; cocoa; whole barley, whole oats (see also here and here); defatted coconut flakes; acai berries; possibly drinking water with baking soda; and hibiscus tea.


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