Cholesterol is a lipid, or fat, that is necessary for the normal functioning of the body. It is used to make hormones, vitamin D, bile acids for the digestion of food and the outer coating of cells. It is made by the liver and is also found in some foods. Although having high cholesterol (also known as hypercholesterolemia) itself does not cause any symptoms, having an excessively high level of lipids in your blood is a risk factor for various health conditions, including atherosclerosis (hardening of the arteries) and heart disease. Atheroclerosis is also called ‘atherosclerotic cardiovascular disease’ – and is often referred to simply as ‘cardiovascular disease.’ There are many risk factors that may in turn come into play when a person has atherosclerosis. One of the most important is hypertension (high blood pressure), which can cause damage to the arteries and result in the restriction of blood flow to the heart and other organs and tissues of the body. Hypertensive atherosclerosis can result in a stroke or heart attack due to a blockage or a rupture, so it is a serious possible consequence of unchecked high cholesterol levels.
Although high cholesterol is linked to atherosclerosis and heart disease, the relationship is not straightforward. There are two types of cholesterol, LDL cholesterol (commonly referred to as “bad” cholesterol), which is directly linked to heart disease, and HDL cholesterol (“good” cholesterol), which is actually protective. The relative amount of HDL to LDL is in fact more important than total cholesterol. Someone with very high HDL levels may be at relatively low risk for heart disease even if they have high total cholesterol levels.
Low-density lipoprotein (LDL) cholesterol circulates in the blood. It is mostly unused. Normally, the liver eliminates this extra cholesterol. However, many people have more LDL cholesterol than their liver can handle. It is this LDL cholesterol that promotes the accumulation of cholesterol-rich fatty deposits in your arteries. This can cause the arteries to become narrower or blocked, slowing down or stopping the flow of blood to your vital organs, especially the heart and brain. If this affects the heart, it is called coronary artery disease, and it can lead to a heart attack. When the arteries that carry blood to your brain are blocked, it can lead to a stroke. High-density lipoprotein (HDL), or “good” cholesterol, on the other hand, can actually help prevent heart attacks and strokes. HDL gains its “good” name by removing LDL cholesterol from the arteries and tissues and bringing it back to the liver where the excessive LDL cholesterol is broken down. Moderate (1-2 drinks a day) alcohol consumption increases HDL cholesterol, but it does not decrease LDL cholesterol. So, alcohol intake may increase total cholesterol levels.
To reduce cholesterol without medication, lifestyle changes are vitally important. Foods that contain saturated fat, hydrogenated fat, and cholesterol (such as animal products, fried foods, and baked snacks) can raise LDL cholesterol levels. It therefore makes sense to cut down your consumption of animal sources of saturated fat such as cheese and meat. People from Mediterranean countries that use significant amounts of olive oil, and consume less saturated fat, appear to be at low risk for heart disease. Research has demonstrated that olive oil lowers LDL cholesterol. Add whole grains, pulses, fruits, and vegetables to your meals to reduce heart disease risk. Plant based foods including vegetable oils, grain products such as cereals and bread, nuts, seeds, legumes, fruit and vegetables all contain plant stanols and sterols too, which have a cholesterol lowering effect which seems to vary between individuals. A healthy diet should contain plenty of these foods, but there are also many foods on the market which have been fortified with stanols and sterols, often accompanied by claims to reduce cholesterol. Commonly these are fat based spreads or dairy type foods such as yoghurts, yoghurt drinks and milks. Although a healthy diet may provide 200-400mg of stanols and sterols a day, it appears that a higher intake than this is required to exhibit a cholesterol lowering effect. This means that adding some of these fortified foods to your diet may be a good idea, but talk to your doctor first if you are on cholesterol lowering medication. There are also supplements available that contain plant sterols (see more below). Eating oats regularly can have a beneficial effect on cholesterol management – as they contain an important cholesterol lowering fibre called beta-glucan (see below), so if you like porridge it makes a great breakfast choice if you have high cholesterol levels. It may also be a good idea to add soya protein to your diet. Just 30 grams a day of powdered soya protein added to food or drinks can help lower cholesterol. Smoking, while not directly affecting cholesterol levels, certainly negatively affects the development of cardiovascular problems such as hardening of the arteries.
Finally, and probably most importantly, you can raise HDL or “good” cholesterol with exercise. Start a regular exercise program and stick to it. This need not be too challenging, just moderate regular exercise can have a profound effect on your LDL cholesterol levels, and has the added benefits of strengthening your heart, improving your mood, and helping you to maintain a healthy body weight which reduces your risk of developing many other health problems. Aim for at least 30 minutes of exercise per day if you can. Even if you make no other changes to your lifestyle – just the simple introduction of some daily exercise can really make a huge difference to your cardiovascular health. In addition to these important changes, there are lots of good supplements on the market for helping to control cholesterol levels too. If you are on any prescribed medication from your doctor, then check before using any of the following supplements.
Red Yeast Rice
Red yeast rice is a substance that’s extracted from rice that’s been fermented with a type of yeast called Monascus purpureus. It’s been used in China and other Asian countries for centuries as a traditional medicine. Red yeast rice contains naturally occurring substances called monacolins. Monacolins, particularly one called Monacolin K (also referred to as Lovastatin) are believed to be converted in the body to a substance that inhibits the production of cholesterol by blocking the action of an enzyme in the liver called HMG-CoA reductase that is involved in the manufacture of cholesterol (1,2). Monacolin K is found in low amounts in red yeast rice, but it is thought to work alongside perhaps as many as ten other monacolin compounds that are also present (3). Studies have shown that red yeast rice can significantly lower levels of total cholesterol and specifically LDL, or “bad” cholesterol. One study showed that taking 2.4 grams per day of red yeast rice reduced LDL levels by 22% and total cholesterol by 16% in 12 weeks. In another study, subjects taking 1.2 grams per day had their LDL levels lowered by 26% in just eight weeks. Like statins, red yeast rice can lower coenzyme Q10 levels in the body. Bio Medical Nutrition Cardio-K contains 334mg Red Yeast Rice Extract (providing 10mg Monacolin K) plus 30mg of coenzyme Q10 to balance this effect. Take 1 capsule per day.
Beta-glucan is a type of fibre that is found in oats and barley, as well as in mushrooms and some yeasts. Beta-glucan binds with cholesterol and bile acids and allows the body to eliminate them as part of the digestive process. This is because beta-glucan is a soluble form of fibre that dissolves inside the digestive tract where it forms a thick gel-like substance. This gel then binds to excess cholesterol and cholesterol-like substances within the gut and helps to prevent them from being absorbed by the body. The gel and the cholesterol are then excreted as part of the body’s waste. Because beta-glucan decreases the amount of cholesterol that the body absorbs from dietary sources, it also encourages the body to use the cholesterol already in the blood for the formation of hormones, which has a further cholesterol lowering effect. Beta-glucan is the key factor for the cholesterol lowering effect of oat bran that has been observed in several scientific studies (4,5). A systematic review of existing scientific studies published in 2016 concluded that ‘Pooled analyses showed that oat β-glucan has a lowering effect on LDL-cholesterol, non-HDL-cholesterol and ApoB.’ (6). Apolipoprotein B is a protein that is responsible for transporting cholesterol around the body, so is used as another way to measure circulating cholesterol. Although most research has been conducted on oat beta-glucan, all forms of beta-glucan appear to exhibit benefit. Results from a number of scientific studies with either oat or yeast derived beta-glucan indicate typical reductions, after at least four weeks of use of approximately 10% for total cholesterol and 8% for LDL (“bad”) cholesterol, with elevations in HDL (“good”) cholesterol of up to 16% (7,8,9,10). Eat porridge oats for breakfast, add mushrooms to your diet regularly and try Viridian Immune Complex, which contains Beta 1,3/1,6 Glucan plus Vitamins C, D & Zinc for immune support. Take 1 capsule per day with food.
Garlic has many documented health properties, and these include a beneficial effect on cholesterol levels which has been documented in many clinical trials (11). Although it has long been believed that the main active in garlic is allicin (produced when a clove of garlic is crushed) it appears that other sulphur containing compounds including S-allyl cysteine and S-allyl mercaptocysteine are important to many of garlic’s beneficial actions in relation to cholesterol. Although adding plenty of garlic to your meals is a good idea, the higher levels of these compounds found in aged garlic supplements are likely to be most effective. In one three-month study, aged garlic was shown to reduce total cholesterol by 7% and LDL cholesterol by 4% in subjects with hypercholesterolemia (12). Quest Kyolic Garlic 1000 is produced from organically grown cloves cold aged for 20 months to produce high levels of these important sulphur containing compounds. Take 1-2 tablets per day with food.
Lecithin occurs naturally in all human, animal and vegetable cells. It is found in high quantities in soya beans, so most supplements are derived from this source. Lecithin is rich in phosphatidyl choline, a nutrient which plays an important role in the breakdown of fat in the liver and the emulsification of fat in food. The believed benefit of lecithin is thought to be a result of its content of polyunsaturated fatty acids. In some studies, supplementing with lecithin has been shown to increase HDL cholesterol and lower LDL cholesterol (13), but despite popular use, its benefit has not been scientifically proven to date. If you want to try adding lecithin to your diet, there are no known side effects, and it is easy to use. Lecithin is most commonly used in granular form. Lecithin granules are virtually tasteless, so they can be sprinkled on foods such as cereals without affecting the taste. Try Biethico Lecithin Granules, which are made from GMO free soya beans. Take one teaspoonful, three times daily. Lecithin granules can be sprinkled onto foods, mixed into drinks or taken directly from the spoon. Lecithin is available in capsules too – such as Solgar Lecithin 1360mg softgels, but this is less cost-effective way to take it.
Also known as phytosterols – plant stanols and sterols are found in a wide range of plant-based foods, as highlighted above. Plant sterols and stanols have a similar chemical structure to cholesterol. They are thought to work by reducing the absorption of cholesterol in the gut so that more is lost in your faeces. This helps to lower total cholesterol and LDL cholesterol in the blood. In terms of benefit there seems to be no difference between stanols and sterols. Although regular consumption of dietary sources of these foods, which include vegetable oils, cereals, legumes, seeds, nuts, fruit and vegetables, can help to maintain healthy cholesterol levels, and there are of course many other benefits to including all of the above in a health diet, normal dietary intake will probably not actively reduce your cholesterol levels if they are already high. The evidence is that an intake of between 1.5g – 3g sterols and stanols daily is required to lower cholesterol, and to get this you can either use fortified foods such as spreads, yoghurt or fortified drinks regularly, or you could consider taking a supplement. Nature’s Aid Cholesterol Support Formula provides plant sterols plus vitamin B1 to support a healthy heart. It is available in an easy to use powder that is both vegan and free from artificial flavours, colours or preservatives. If you are taking cholesterol lowering medication, it is important to talk to your doctor before trying sterol supplements.