Photo by Rob Hawthorne
Busy raising his three children and tending to his growing writing and consulting business, Dave Taylor was never concerned about cholesterol. That changed last summer, however, when the 42-year-old learned during a routine checkup that his total cholesterol count was 265. “I’ve always been very healthy, so I was surprised to learn my cholesterol was that high,” Taylor says.
His doctor asked if he wanted a prescription for a cholesterol-lowering medication, but Taylor said no. “I would much rather try to get my cholesterol down through diet and exercise than take a drug for an extended period of time,” he says.
After being made aware of his elevated cholesterol, Taylor, who had already given up red meat and poultry, swore off fried foods and dramatically reduced his sugar intake. He also began walking briskly for at least 30 minutes each day. Taylor says he’s been able to keep to his walks, except during crunch times at work when he can go two to three weeks with little opportunity for exercise.
Dave Taylor: What’s a good cholesterol-level goal?
Pamela Popper, Phd, ND: In the United States, we historically have considered a total cholesterol count below 200 mg per deciliter of blood to be safe. But if you look at healthy populations, for example people in China, their cholesterol levels range from a low of 70 to a high of 170.
With that in mind, I would advise you to shoot for a total count of 150. Long-term studies such as the Framingham Heart Study—an ongoing heart disease study started in 1948 and administered by the National Heart, Lung, and Blood Institute—have shown that death caused by cardiovascular disease does not occur in people with cholesterol counts below 150.
Q. My total cholesterol count is 265, but my LDL (low-density lipoprotein) level is 167, my HDL (high-density lipoprotein) is 50, and my triglycerides are at 243. What do these numbers mean?
A. LDL cholesterol is referred to as “bad” cholesterol because it can build up on the sides of the arteries and form plaque, which eventually slows blood flow through the arteries. I would advise you to keep your LDL cholesterol under 100.
HDL is referred to as “good” cholesterol because it carries cholesterol away from the arteries and back to the liver, where it is eliminated from the body. HDL cholesterol should comprise one-quarter to one-third of your total cholesterol.
Triglycerides are a form of fat. An optimal level is 100, although many health care professionals say that 150 is acceptable.
Q. Aside from cardiovascular disease, are there other health risks associated with high cholesterol?
A. Cancer is another health risk that has been tied to elevated cholesterol levels. In the China-Oxford-Cornell Diet and Health Project [also known as the China Study], T. Colin Campbell, PhD, at Cornell University, found that the risk of certain types of cancers seems to go up when cholesterol goes up.
Q. What can I do to lower my cholesterol naturally?
A. Most people think that you end up with elevated cholesterol by consuming dietary fat and cholesterol. But actually, cholesterol levels are most dependent on animal protein consumption. When we compare the diets of those who have low risks of heart disease, cancer, and other diseases (such as people in China and Japan), one of the biggest similarities is that the percentage of calories they consume from animal-based foods is quite low.
Therefore, I recommend a plant-based diet to help patients lower their cholesterol. This means that 90 percent of your calories come from fruits, vegetables, whole grains, legumes, nuts, and seeds, and the remaining 10 percent come from animal-based foods. With this diet, no more than 20 percent of your calories should come from fat. I advocate consuming most of this fat from plant sources, such as nuts, seeds, olives, and avocados. In addition, you want to avoid eating all trans fats.
Finally, you should consume 45-plus grams of fiber a day and eat most of your food in its natural state. When choosing carbohydrates, stick with complex carbohydrates such as vegetables, legumes, and whole grains rather than white breads and pastas and other refined carbohydrates. These latter foods can cause your insulin levels to spike, which can potentially lead to insulin resistance—a condition that can dramatically worsen an already abnormal lipid profile.
Q. How can I get 45 grams of fiber into my daily diet?
A. It’s really not difficult. You can start with a breakfast smoothie that has soy protein powder, a banana, and frozen berries, plus a tablespoon of ground flaxseeds. This drink contains 14 grams of fiber. Later in the morning, eat some multigrain cereal with fruit and rice milk and get another 9 grams of fiber. For lunch, eating split pea soup with a big salad will provide 16 grams of fiber. Eating two veggie wraps for an afternoon snack will get another 6 grams of fiber. For dinner, eat two baked sweet potatoes and a big salad for an additional 12 grams of fiber. In total, you’ll have consumed about 57 grams of fiber. This is a lot of food to eat during the day, but one nice thing about this type of diet is you can eat to your heart’s content and you’ll become full before you overeat from a calorie standpoint.
Q. How important is exercise for lowering cholesterol?
A. I tell people to aim for exercising five to six days a week, during which time they get into their target heart rate zones for 45 to 60 minutes. If you’re in your zone, you could carry on a conversation, but you would rather not. As part of your workouts, you also want to add in strength training and stretching by doing Pilates or yoga.
Q. If I make the dietary and exercise changes you suggest, how soon can I expect to see my cholesterol drop?
A. According to a study published in the July 2003 Journal of the American Medical Association (vol. 290, no. 4), a plant-based diet was as effective in lowering cholesterol levels as statin cholesterol-lowering medications. In this study, the diet lowered cholesterol levels by an average of 29 percent in one month.
Q. Is it possible that even after making these lifestyle changes I will need to go on one of these drugs?
A. Taking cholesterol-lowering medications long term can have some potentially serious side effects, including liver failure and muscular degeneration. Therefore, if the lifestyle changes do not sufficiently lower your cholesterol within three to six months, I would recommend you work with a naturopath or health care practitioner to add in some cholesterol-lowering supplements, such as niacin. (See “Ask Your Doctor about These Supplements,” above, for more specifics.) If supplements don’t bring the cholesterol down within another few months, you would need to take medication. But even with the supplements and medication, you still need to maintain a healthy diet and exercise regimen.
Carlotta Mast is a frequent contributor to Delicious Living.