Thursday, February 4, 2010

Foods to Lower Cholesterol

In this blog we will talk about some evidence-based food strategies for lowering cholesterol, with an emphasis on our two favorite dietary interventions, chocolate and beans. (Beans feature in our recipe for Mexican Brown Rice with Black Beans at the end of this post.)

Whatever the target LDL level your physician sets for you, including cholesterol-lowering foods may allow you to reach that target without medications; or, when medications are required, a significantly lower dose will often be enough. This may mean lower cost and fewer side effects. In our medical practice we often see people able to reduce their medications by 50 - 75% and still maintain good control. Not uncommonly, thoughtful food choices can allow you to stop cholesterol medication entirely. The more of the following foods you eat on a daily basis, the better your results will be. (...and as a rule, allow any food program at least six weeks to work.)
Take an ounce of dark chocolate
and call me in the morning

February is officially heart health month. For those of you who cared so much about the heart health of others that you actually sent them dark chocolate on February 14th, congratulations! You are practicing evidence-based love. And if there is one thing we could all use, it’s love with good outcomes data. Here are some cardiovascular benefits of small amounts of cocoa or dark chocolate daily:
1. Lower risk of heart disease and death, and greater survival in those who have a heart attack in epidemiological studies [1]

2. Lower blood pressure [2]

3. 6% lower LDL (‘bad’ cholesterol) levels, 9% higher HDL (‘good’ cholesterol) [3]

Sadly, we need to use good sense when eating chocolate. This means we should choose high-potency dark chocolate, which means a cocoa content of 70% or higher. If the label doesn’t specify a cocoa percentage, find one that does! As for the recommended daily allowance, up to three ounces a day have been studied, but one ounce a day (or even less) should give you adequate cardiovascular benefit. And if you are adding chocolate to your diet, remember to remove some calories somewhere else.

Why you should be nice to beans

We’re glad you have read this far, because we want to talk about a food that’s even better for your heart than chocolate. We want to talk about – beans! We look for any excuse to speak up for beans because they are usually not appreciated when they try to speak for themselves. There is no bean lobby to represent them in the corridors of power because beans are too honest to mix with politicians, and too cheap to make anyone rich.

Beans are, however, possibly the most effective – and certainly the safest – lipid lowering agents you can find. For example, one half-cup daily of cooked pinto beans can lower LDL (‘bad’ cholesterol) 8% or more. [4] (Other legumes are probably equally heroic, but it was the pinto bean that was studied here. One of our favorite ways to study the pinto bean is on the dinner plate pictured further down.) If an 8% reduction doesn’t seem like much, look at it this way: the bean effect is similar to doubling the dose of most ‘statin’ cholesterol lowering drugs, but without the cost or risk.

...and by the way, the benefits of beans also extend to reducing your risk for diabetes and cancer, particularly breast cancer. In the Nurses Health Study II, a serving of beans or lentils twice a week was associated with a 24% reduction in breast cancer risk. [5] Just think about the reduction in health care costs if more prescriptions were written for beans!

Some other foods to lower LDL

■ A daily dose of 10 grams psyllium (about 2 heaping teaspoons) can sometimes reduce LDL by about 7 percent.
[6] In some studies, psyllium has failed to lower LDL but has had a beneficial effect in raising HDL and lowering triglycerides.[7] Most people stir psyllium into water or juice. A method that works well is to stir it into a small amount of water, drink it quickly before it gels, and then follow with 12 ounces of water. Psyllium is a great anti-constipation agent, too.

■ Using 4 tablespoons (¼ cup) of oat bran each day may give about 10 – 26 percent reduction in LDL.
[8] Oat bran can be added to cereal, stirred into yogurt or smoothies, or added to muffins. (See recipe for Extreme Muffins on page 236 of Good Food, Great Medicine.)

■ About two handfuls of raw almonds (about 30 almonds or two ounces) daily can reduce LDL by 9 percent. Raw walnuts, hazelnuts, Brazil nuts, and pecans probably work as well. Adding raw nuts to your diet also has the important benefit of reducing oxidized LDL as well as another risk factor called Lp(a).
[9] Remember that whenever you add a high-calorie food (like nuts) to your diet, you need to reduce calories elsewhere.
■ About 6 ounces of eggplant or about 3 – 4 ounces of okra every other day can also lower LDL. These foods have not been studied by themselves, but when used in combination with other factors, have been found to lower LDL by 28 percent. Inflammation was reduced as well.[10]

Soy foods modestly reduce cholesterol. These are probably best included in the diet in the form of whole traditional soy foods such as soybeans (edamame), tofu, miso, and tempeh. (See recipes for Seductive Soybeans and Tofu in Soy Ginger Marinade on pages 158-60 of Good Food, Great Medicine.) I am less enthusiastic about the highly refined soy products like soy milk. For those who use soy milk because of dairy intolerance, read the ingredient label carefully. Some other beans also lower LDL to a similar degree, particularly pinto beans. A half-cup of cooked pinto beans or 25 grams of soy protein will lower LDL 5 percent or more.[11]

■ There are a variety of stanol-containing margarines that can lower LDL cholesterol. I don’t tend to recommend them because of concerns over the problems with hydrogenated oils in the margarine, and the debate over whether stanols at these doses have potential for harm.
[12] Time will tell.

[1] Janszky, I J Intern Med 2009;266:248-57
[2] Hooper, L. AJCN 2008;88:38-50
[3] Harned MS. Southern Med J 2008;101:1203-8
[4] Winham DM et al. JACN 2007;26:243-9
[5] Adebamowo, A et al. Int J Cancer 2005;114:628-33
[6] Am. J. Clin. Nutr. 2000;71:472-9
[7] Sola, R.Am J Clin Nutr 2007;85:1157-63
[8] JACN 1998;17:601-608
[9] Circulation 2002;106:1327-32
[10] Jenkins JAMA 2003;290:502-510
[11] Winham DM et al. JACN 2007;26:243-9
[12] Fransen J Nutrition 2007;137:1301-6

Wondering what to feed the cardiovascular system you love? We suggest Mexican Brown Rice (recipe below) and Avocado Salsa. These recipes can be found on pages 175 and 131 of our cookbook and lifestyle guide, Good Food, Great Medicine.

Mexican Brown Rice
with Black Beans

(Pinto beans may be better for reducing LDL cholesterol - but the contrasting color of black beans make a better looking dish, I think.)

This is a last-minute one-skillet dinner that also offers complete protein in the bean-and-rice partnership. If this recipe didn’t taste so good, you might suspect some other reason for its existence, like nutritive value or ease of preparation. It is at its best freshly made, but it still makes lovely leftovers. If you are struggling with excess weight or diabetes, we suggest that you replace a cup of the rice with an extra cup of beans.

(Serves 3 – 4 as main dish)

¼ cup extra-virgin olive oil
3 cups diced onion (a medium-large onion)
1 tablespoon chili powder (mild)
1 teaspoon ground cumin
1 teaspoon salt
1 green bell pepper, diced
1 fat teaspoon freshly crushed garlic

2½ cups cooked brown rice (see page 171 of Good Food, Great Medicine)
¼ cup lemon juice
½ teaspoon freshly ground pepper
1 can (14 ounces) black beans, rinsed and drained
1 can (14 ounces) diced tomatoes, drained
½ cup chopped fresh cilantro

1. Heat oil in 10-inch skillet over medium high heat and sauté onion, chili powder, cumin, and salt for about 5 minutes.

2. Add diced green pepper and sauté for another 5 minutes. Reduce heat to medium. Add garlic and sauté for another 2 minutes. (This dish seems to call for a fresh crunchiness, so sauté with an easy hand and a reckless Latin spirit. The green pepper should be tender but still bright green.)

3. Add rice, lemon, pepper, black beans, tomatoes, and cilantro. Toss gently, breaking up any lumps of rice, until the mixture is hot throughout. (Check to make sure there’s enough salt – you may need to add another ¼ teaspoon.) Serve and eat while steaming hot.

If you use chopped fresh tomatoes, use plenty – they have a milder flavor than the canned, and their fresh juiciness is a lovely addition. Make sure you add them just before serving, if possible — cooking tends to turn them to mush.