Lowering Cholesterol Through Diet

The Mediterranean diet is still considered
one of the best ways to control cholesterol

By Theodore Wissink, MD, family physician,
Penobscot Bay Family Medicine, Rockport

Cholesterol is important for good health. It is needed for making cell walls, tissues, hormones, vitamin D and bile acid, which aids in the digestion of food. A waxy, fat-like substance, cholesterol is found in the blood and the cells of the body. The body gets cholesterol in two ways. Some is made in the liver. The rest comes from eating foods from animals such as egg yolks, meat and whole-milk dairy products.

Why do we need to manage our cholesterol? Too much cholesterol in the blood can build up in the walls of blood vessels and block blood flow to tissues and organs. This can increase the risk of developing heart disease and stroke.

For people without heart disease, studies have shown that lowering cholesterol levels can reduce the risk of developing heart disease. This is true for both those with high cholesterol levels and those with average levels.

For people with heart disease, studies have shown that lowering cholesterol can reduce the risk of dying from heart disease, having a nonfatal heart attack, and needing heart bypass surgery or angioplasty (surgery to unblock or repair a blood vessel).

A person can get too much cholesterol in two ways. First, high blood cholesterol can run in families. The amount of cholesterol your body makes and the way your body controls its cholesterol levels can be affected by your family health history.

Second, a person’s diet may include too many foods high in cholesterol. And, although cholesterol is found only in foods from animals, any type of food – whether from animals or plants – can contain fats, which cause the body to make even more cholesterol.

Cholesterol is measured through a simple blood test known as a lipoprotein profile. The desirable ranges include:

• Total cholesterol: Less than 200 mg/dL
• Low Density Lipoprotein (LDL) cholesterol ("bad" cholesterol): Less than 130 mg/dL, but less than 100 mg/dL if diabetic or history of heart disease.
• High Density Lipoprotein (HDL) cholesterol ("good" cholesterol): 40 mg/dL or higher
• Triglycerides (another kind of fat found in the blood): Less than 150 mg/dL

Eating right, exercising regularly and managing your weight are the most important ways to lower your cholesterol and prevent heart disease.

The Mediterranean diet

People who live in countries bordering the Mediterranean Sea have been found to have less heart disease than those in the U.S. and other western countries. There is no one standard Mediterranean diet. Diets in these countries differ but have some common features.

A Mediterranean diet that is rich in plants is a good source of plant sterols and stanols and is one way to lower cholesterol. Sterols and stanols are types of fat found in plants such as fruits, vegetables, nuts, seeds, cereals, legumes (e.g., peas, beans, lentils, peanuts) and vegetable oils (particularly soybean oil). They limit cholesterol absorption through the gut by approximately 50 percent.

In the four-year Lyon Diet Heart Study, compared to people who ate a careful diet (low fat), the people who ate the Mediterranean type diet had a 50 to 70 percent lower risk for recurrent heart disease. Moreover, the Mediterranean diet was three times more effective than statin drugs in preventing a second heart problem. (Statins are drugs that are prescribed to lower cholesterol levels).

A logical reason for this is that the Mediterranean diet provides the body with many more benefits than the drug does. The vegetables, fruits, fiber and essential fatty acids in the diet not only help reduce cholesterol, but also may reduce inflammation, cancer risk, the development of arthritis and Alzheimer’s disease. Good nutrition increases the health of the whole body – not just the heart.

The Integrative Medicine Program at the University of Michigan has developed an easy-to-follow food pyramid that defines key ingredients of a Mediterranean diet. It can be accessed at http://www.med.umich.edu/umim/clinical/pyramid/index.htm

Are there other ways to prevent heart disease?

Avoid smoking. Smoking lowers HDL (the good cholesterol) in your body. It also makes it difficult to get the activity you need to help reach healthy cholesterol levels.

Although there are no known data to show that emotions affect cholesterol, studies show that stress is one of the key risk factors for developing heart disease. Cultivating positive attitudes like peacefulness and compassion can significantly improve your health and quality of life if you tend to feel negative emotions (e.g., anger, hostility) often throughout the day.

Dr. Theodore Wissink is a family physician with Penobscot Bay Family Medicine in Rockport.