Tired of the media onslaught promoting statin drugs? What happened to a conversation
about nutritional strategies that reduce cholesterol?

There are indeed ways to significantly reduce cholesterol using common foods and nutritional supplements. Reductions in LDL cholesterol of 25, 30, 50, even 100 mg/dl are possible—if you know what and how. Here’s the Track Your Plaque guide to natural strategies to reduce LDL that supplement, sometimes replace, your need for prescription medication.

In an age when statins dominate conventional heart disease prevention, an important role remains for nutritional approaches. Because statin drugs are principally LDL-reducing agents and do not address other causes of heart disease, nutritional strategies add real advantage. Nutritional approaches can be used to minimize and sometimes eliminate use of statin drugs altogether. Perhaps it’d be better to regard statin therapy as a solution only when natural, nutritional means have been exhausted.

In the Track Your Plaque program, we aim to reduce LDL cholesterol to ≤60 mg/dl (though not below 50 mg/dl, since the long-term implications of cholesterol this low remain unexplored). Even better, we aim for an apoprotein B <70 mg/dl or LDL particle number <700 nmol/l, improvements over the conventionally calculated LDL cholesterol. (Of course, always discuss these issues with your doctor.)

Just adhering to a healthy diet is not enough in the majority of cases. The American Heart Association’s diet, for instance, yields a 7% drop in cholesterol. That’s too small to make any real difference (Pearson TA et al 2002) and, by itself, virtually guarantees a future of heart disease! The formerly popular ultra low-fat diets (≤10% of calories from fat) yield variable drops in cholesterol, but HDL is also substantially reduced and triglycerides increased (Krauss RM et al 1995). Our experience with the ultra low-fat diets is that they yield disastrous changes in lipoproteins. The net effect can be increased risk of heart disease and diabetes.

While dietary restriction of total fat intake has only limited power to reduce cholesterol, avoidance of saturated fat (e.g., in butter, greasy meats, cured meats, fried foods) and hydrogenated fat (“trans fats” in margarine, shortening, and many processed foods) remains a well-proven means of reducing LDL cholesterol modestly. Replacing saturated fat sources with healthy monounsaturated oils (olive, canola, flaxseed) provides even greater benefits for cholesterol reduction, as well as reduced triglycerides and VLDL (Gulesserian T et al 2002; Williams CM et al 1999).

Weight loss (if you’re overweight) has broad effects on risk reduction: reduction of cholesterol levels (total and LDL), increased HDL, reduced triglycerides, and correction of small LDL, VLDL, and abnormal postprandial (after-eating) fat clearance (Miller WM, 2005). Restriction of processed carbohydrates is an effective way to lose weight and thereby reduce cholesterol, particularly for people starting with lower HDL and higher triglycerides. Reducing intake of flour products (pasta, breads, bagels, pastries, cookies, cakes, pretzels, and other processed foods) may, in fact, yields larger drops in cholesterol than now outdated low-fat diets (Krauss RM et al 2006).

Beyond diet, nutritional supplements and foods (“functional foods”, or foods that can be used to specific achieve specific goals) can pack real power to reduce cholesterol (total and LDL). For most people, no one supplement or food by itself will reduce LDL to your target. A combination of several strategies usually yields the large drops that we need to achieve dramatic LDL reduction.

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