Looking Beyond Lowering LDL Cholesterol

The risk of developing cardiovascular diseases is typically assessed based on a standard cholesterol test measuring LDL (low-density lipoprotein) and HDL (high-density lipoprotein) levels and then factoring advanced age, gender, family history of heart disease, high blood pressure, diabetes, and smoking. Taking these factors into account, LDL lowering targets can then be established, and a program of therapeutic changes in lifestyle and nutrition can be established. If these changes are unable to bring cholesterol levels in line, medications are routinely provided.

However, studies indicate that these risk factors can account for only a portion, perhaps 50%, of the incidence of coronary artery disease. The scientific community has continued its investigations, and is finding that a number of other risk factors can be identified through blood test. On its website, Berkeley Health Lab, a leading medical lab with an integrated program for cardiovascular treatment, identifies many of these important factors including:

Size of LDL Particles: Some LDLs Are Worse Than Others

• Small LDL particles can cause plaque build up to progress much faster because they can enter the artery wall easier than large LDL particles
• Too many small LDL particles can increase your risk for a heart attack beyond any other risk factors you may have, such as smoking, high blood pressure, diabetes, etc.
• Certain medications, proper nutrition, and regular exercise can help your body produce fewer small LDL particles

Size of HDL Particles: Some HDLS Are Better Than Others

• HDL helps to protect against progression of plaque build-up in the artery wall
• HDL2b is the workhorse of all of the HDL particle types. It has the ability to pick up and remove cholesterol
• Certain medications, improved nutrition, loss of body fat, stopping tobacco use, and increased physical activity are some ways that HDL-C and HDL2b can be improved

Apolipoprotein B: Accurate LDL Particle Number

• ApoB is a direct measurement of the amount of LDL ("bad" cholesterol) particles
• A high apoB number indicates increased risk for heart disease
• Improved eating habits, increased physical activity, and loss of body fat are some lifestyle changes that improve apoB
• Your physician uses apoB to determine if certain medications are needed and to monitor their effectiveness

C-Reactive Protein-hs (CRP)

• High levels of CRP indicate inflammation within the body due to infection or tissue injury; it can also predict heart disease risk levels
  Certain medications may help reduce this risk
  Certain foods have anti-inflammatory benefits

ApoE Genotype

• ApoE is a genetic test that plays a role in helping to identify how people respond to different amounts of dietary fat. Your body's response to dietary fat impacts the formation of small or large LDL particles
• There are 3 types of apoE genotypes: apoE2, apoE3 and apoE4
• People with an apoE4 have a greater risk for heart disease
• ApoE can be used to help guide the right nutrition plan for you

Other risk factors measurable through blood tests also are discussed on this site.

Overall, most of us typically receive the standard test for cholesterol, with these more thorough tests reserved for those individuals at high risk. Yet, for those of us interested in the information needed to optimize our long term health, this more complete assessment can be very useful. Check with you healthcare provider about obtaining these more extensive blood test to better direct your unique course for optimizing your health.

Foods with Plant Sterols

Plant sterols are an effective nutritional tool for lowering LDL cholesterol by 10-15%. As part of a diet that is both low in saturated fats, trans fats and cholesterol, and high monounsaturated fats and soluble fiber from oats, beans, barley or psyllium, individuals can achieve cholesterol reduction of 30%+.

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils. The average plant sterol intake is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods or supplements are typically required to obtain these levels.

Click for Chart of Foods with Plant Sterols

kardea - gourmet nutrition for cholesterol management

Foods with Plant Sterols

In nature, small quantities of plant sterols can be found in a range of foods, particularly vegetable oils. In the American diet, the average plant sterol intake is about 250 milligrams. Vegetarians consume in a range of 400 to 750 milligrams. Plant sterol intake in traditional diets has been estimated to be about 1g (1000mg). Medical studies have concluded that 2-3g (2000-3000mg) effectively lower cholesterol. Fortified foods or supplements are typically required to obtain these levels.


At our sister site, Kardea Gourmet, you can find a listing of a variety of foods with plant sterols --- naturally-occurring and fortified. You also can find (and contribute) great recipes for foods that actively work to improve cholesterol levels.

Father's Day Gourmet & Cholesterol Management

The science is clear and convincing. Therapeutic nutrition---that incorporates 2g of plant sterols, over 10g of soluble fiber, monounsaturated fats replacing saturated and trans fats, and reduced animal sources of protein-- can achieve cholesterol reductions comparable to many of the widely prescribed medications.

With my daughter, we have created a delicious, natural, cholesterol-lowering Father’s Day menu.

We recommend recipes for lunch, a snack and dinner. With a single serving of each dish, you will enjoy:

• 2g of natural plant sterols from foods and taken through the course of the day.
• 30g of total fiber
• 7 grams of heart healthy soluble fiber.
• 1g Omega-3 fatty acids (EPA/DHA)
• Only 150mg of dietary cholesterol (from the chicken and salmon)
• Saturated fat is below 7 percent of total calories.
• Monounsaturated fats equal about 23% of total calories.

Overall, we are nearly in-line with the recommendations of the National Cholesterol Education Program, but we fall a bit short on the heart healthy soluble fiber.

So look to breakfast to finish your therapy. Here are some simple guidelines. A good morning start would be an oat cereal and fruit. If you are looking for something a bit more interesting, there are a number of oat pancake recipes that can be found online. Stay away from the ones with butter and lots of eggs in the ingredients. Either way, you should get you to the 10g minimum recommendations for soluble fiber.

In my life, I actually shoot for the higher, 20-25g recommendation. The only way I have been able to achieve this goal is with psyllium husk or concentrated oat bran. I dissolve a tablespoon of one of these fibers into my morning juice. A heaping tablespoon of the psyllium husk, for instance, delivers 9g of heart health soluble fiber. Most people can tolerate such a dosage, but it is probably something you need to work up to.

The Menu

Luncheon
Mediterranean Salmon Salad
Chick Peas with Oregano
Roasted Asparagus
Whole Grain Bread or Whole Wheat Roll

Snack
Kardea Gourmet Nutrition Bar with 1g plant sterols, 7g fiber, and 7g protein.

Dinner
1st Course
Gazpacho: Quick, Bold & Delicious

2nd Course
Chicken Balsamic Reduction
Steamed Broccoli
Barley Pilaf

Dessert
Sorbet of Your Choosing
Fresh Berries or Sliced Ripe Peaches.

NBC News Reports: Plant Sterols-A Natural, Safe & Easy Way to Lower Cholesterol

Wednesday, April 8, 2008
Reported by: Joe Vignolo, Denise Nakano, NBC News

A natural, safe and easy way to lower cholesterol. It's been around forever, but chances are, it's one alternative medicine you have never heard of.

"Nowadays, it is no longer good enough to know your total cholesterol level. You really need to know your breakdown - the breakdown between the good and the bad," said cardiologist Dr. Daniel Rader. This is the bad stuff: too much LDL, or bad cholesterol, circulating in the blood. It builds up in the arteries, slowly narrowing them or forming clots. And that can lead to heart attack or stroke.

Medicine can help, "but, there are an awful lot of people who have cholesterol levels that are higher than they should be, but not so high that they really need medication," said Dr. Rader.

Diet and exercise work. And, Dr. Rader says, so can eating phyto or plant sterols, naturally found in fruits, vegetables, nuts and seeds, added to other foods like spreads and snack bars, or taken as a supplement.

"There's no question that phytosterols, or plant sterols, are one of the best proven - if you will - 'alternative' methods of lowering cholesterol, short of drug therapy," said Dr. Rader.

Dr. Rader is a specialist in preventive cardiac medicine. He is a strong believer in plant sterols for people with high cholesterol who don't yet show signs of heart disease. He says they have almost no side effects and are safe for children and teens.

Research finds they can reduce bad cholesterol by 10 to 15 percent. And you can use them in combination with cholesterol-lowering prescription drugs. "I've never had really serious cholesterol trouble, but each time I went to the doctor, she was warning me that it was inching up," said David Hollenberg, who tried plant sterols. Hollenberg says he has never been shy about alternative medicine and decided to give a plant sterols supplement a try. He doesn't know yet what impact they have had on his cholesterol, but he thinks it is worth a try.

"Plant sterols are one of the rare things in the alternative medicine world that actually have been studied, have been proven to work, and are actually endorsed by people like me: card-carrying, regular doctors who actually think that this really makes sense to do," said Dr. Rader.
If you decide to try plant sterols to lower your cholesterol, dose really matters. To be effective, you must take it every day and be sure you're getting enough. For example, one or two tablespoons of sterol-containing spread a day has what you need.

Kardea Nutrition foods with plant sterols.

Natural Cholesterol Management - Numbers are In

In a four month period, I naturally lowered my LDL (bad) cholesterol from 161mg/dl to 131mg/dl (about 19% improvement), increased my HDL (good) cholesterol from 55 to 61 (about a 10% improvement). Total cholesterol was reduced from from 228 (it had been as high as 239) to 201. I am not yet at the "under 200" target, but with my relatively high HDLs and declining LDLs, I was now closing in on some desireable cholesterol levels.

I achieved these goals with a less-than-disciplined, natural approach combining plant sterols, viscous soluble fiber and low levels of immediate release niacin from nicotinic acid.

I always have eaten fairly well. Low in terms of red meat and dairy, low in terms of saturated fats, processed foods and dietary cholesterol. Mediterranean cuisine also has long been a personal preference, and I use olive oil (and occassionally canola oil) in all cooking and food prep. I also eat a fair amount of vegetables and whole grains, and lots of fruit.

My internist had suggested that I might need to consider the use of a medication to achieve better cholesterol levels. As an otherwise healthy 49 male, I was not ready to start a lifetime of medication to create healthier cholesterol levels. I began a search for the alternatives, and found that a number of nutrients ---viscous soluble fibers, plant sterols, niacin and Omega-3 fatty acids --- can collectively enable an individual to substantially improve one's blood lipid profiles.

So, I began developing a personal program that incorporates these nutrients in foods and supplements. More importantly, I was looking to enjoy these foods (food and cooking are my pre-occupation and a source of daily joy). With my somewhat less-than-disciplined approach to consuming soluble fiber, plant sterols and niacin, I achieved the results noted above.

Note on full disclosure: While I weigh about the same amount, I did increase the frequency of exercise from 2 to 4 days per week. My workout intensity also increased.

I am now looking to refine my approach to further improve my blood lipid levels. As someone with year's of experience in the natural and gourmet foods, I also decided to create Kardea Nutrition to develop products that comfortably fit into my daily eating habits (and hopefully yours!). I also do not want these foods to lead to an increase in the total level of calories I take in each day.

My first set of products should be available in early February, but early in Janary, you will be able to log onto my website to see what's coming (http://www.kardeanutrition.com/).

Overall, I am sincerely interested in networking with others that are attempting to manage cholesterol levels naturally. Let's share what is working.....and based in part on these exchanges, I will be developing other foods and supplements that strive to meet the combined goals of delicious, natural, calorie-mindful and effective in terms of natural cholesterol management.