There's a new conversation brewing in the cholesterol world. (By "new" I actually mean dating back over a decade, but finally starting to percolate up into the consciousness of the public and practicing physicians, who now often rely on patients for the newest information).
I'm referring to the fact that cholesterol is not always cholesterol. LDL (bad) cholesterol, for instance, is really a smorgasbord of different particles.
LDL cholesterol actually consists of:
- Large particles-which are relatively harmless unless present at high levels.
- Small particles-which are bad news, far more likely to cause heart disease.
- Lipoprotein(a)-a really bad particle that can be cleverly disguised as LDL cholesterol.
To further muddy the picture, conventional LDL cholesterol is a calculation, not an actual measurement. The calculation is prone to enormous inaccuracy. Although in past we told people that the calculation was pretty reliable, rarely varying from the real value by more than 25 mg/dl, in my experience as a lipid consultant and cardiologist over the past 15 years, calculated LDL cholesterol is commonly up to 100% inaccurate. Thus, an LDL of 118 mg/dl might be really 70 mg/dl; it might be 220 mg/dl. It might be all small or all big, or some combination of the two. Imagine your accountant were allowed such sloppiness!
Can I make these distinctions by just looking at you or your cholesterol panel? Nope.
Anyway, I start my comments with these observations just to cast doubt in your mind about the reliability of the usual conversation about cholesterol. I wouldn't go so far as to call the cholesterol argument a scam, but I do believe there is an enormous sea of mis-information being handed to the public.
I also tell you about the uncertainties of the conventional approach to cholesterol to explain why I have found some unconventional ways that can substantially drop cholesterol, often so much that cholesterol drugs can be reduced or avoided.
According to standard wisdom, if LDL cholesterol is high, cut your saturated fat and it should go lower. The truth: this approach is a miserable failure, yielding a few points drop in LDL, rarely more than 20 mg/dl at the extreme. Why: Because LDL cholesterol is not always LDL cholesterol; LDL cholesterol can be many different things influenced by other factors.
That said, here are a number of unconventional ways that can significantly reduce your LDL cholesterol:
- Oat bran-A fabulous, inexpensive source of the fiber beta-glucan, that can reduce both large and small LDL by 10, 20, 30 mg/dl. Use oat bran as a hot cereal micro-waved with skim, 1%, or soy milk with walnuts, blueberries, etc. Or, you can add a teaspoon or two to yogurt or cottage cheese, even "bread" chicken, fish, eggplant, or other foods. (You may need to hunt for oat bran in the bottom shelf of the supermarket cereal aisle or at a health food store, since it is not a high-ticket, high-profit food, often hidden in some corner.)
- Ground flaxseed-Similar to oat bran but essentially devoid of digestible carbohydrates, it is a wonderful way to reduce LDL (small and large) and obtain healthy fiber. Use it just as you would oat bran, as a hot cereal or added to other foods.
- Elimination of wheat products-Yes, that's right. I know it sounds weird. Elimination of wheat products is an enormously-enormously-effective strategy that reduces the small LDL particles drastically. Small LDL particles have exploded in recent years, often dominating total LDL. For this reason, eliminating any food made with wheat flour, such as all breads (white, wheat, whole grain), pastas, breakfast cereals (unless oat based), crackers, pretzels, etc. yields drops in LDL of 20, 30, 50 mg/dl, sometimes more, depending on how much small LDL is present. Get your fiber from oat bran, flaxseed, vegetables, fruits, and nuts instead. Interestingly, people who eliminate wheat find it easier than just cutting back on wheat. I believe this is because wheat has an addictive quality that makes you want more and more and . . .
- Avoidance of high-glycemic index foods-Along with wheat, this includes candies, soft drinks, cookies, white potatoes, white rice, etc. This effect develops if small LDL is present.
- Raw nuts-A really great way to reduce LDL. Nuts got a bad name from the processed, salted, hydrogenated-oil soaked products that dominated supermarket shelves. Instead, look for raw almonds, walnuts, pecans, and pistachios.
¼-1/2 cup per day can yield significant reductions in LDL and do not make you fat, since high fiber and monounsaturated fat content provide a feeling of fullness that diminishes appetite for other foods.
- Niacin-Yes, yes, I know: The hot-flush effect is annoying. Niacin is vitamin B3 and I have well over a thousand patients taking it. Niacin is as effective as statin drugs in reducing LDL; it's also the best agent available (after weight loss and elimination of wheat) for reducing the dreaded small LDL particles. I am partial to the Sloniacin brand made by Upsher Smith (I have no relationship with them), since it is safe, proven, and yields less hot-flush. Any dose higher than 500 mg per day really should be taken under medical supervision. Drinking up to 16 oz water if you get the hot flush is tremendously effective in eliminating this annoying effect.
Other methods to reduce LDL include the stanol esters from the butter-substitute, Benecol
®, and soy foods rich in soy protein like tofu, soy protein powder (as a smoothie, for instance), and soy milk.
Nutritional supplement fans will note the absence of red yeast rice, policosanol, pantethine, and some others purported to reduce LDL cholesterol. However, I have not found consistent, reliable effects with any of these agents. Please also note that fish oil-one of my favorite supplements in the world-is not on the list because it does not reduce LDL cholesterol. It raises it, in fact, because of the shift of VLDL particles into the LDL class-an important topic for another post.
In my view, statin cholesterol drugs are a last resort useful when strategies like this have failed to yield the goals you and your doctor desire.