Written by Student Dietitian Victoria Oleghe (Birmingham City University Student, October 2023)
Checked by Registered Dietitian Nishti
In this blog, you are going to learn which foods help reduce cholesterol levels but first let me give you some background information. Cholesterol is a waxy, fat-like substance that’s found in all the cells in our body. Our body needs some cholesterol to make hormones, vitamin D, and substances that help us digest foods. Our body has the ability to make all the cholesterol it needs. Cholesterol comes in many forms and is made when lipids combine with protein to form lipoproteins. Here is a list of the various forms of cholesterol.
- Low-density lipoprotein (LDL) is considered the bad guy! Too much of this in our body will eventually block the walls of our blood vessels by depositing fatty layers. Think about it, when something keeps depositing over time without anything clearing out the deposit, that passage is going to be narrower and with time it’s going to burst! This is when heart attacks and strokes occur.
- High-density lipoprotein (HDL) is often called good cholesterol because it absorbs all the bad cholesterol in our blood and sends it to the liver to be flushed out from our body.
- Triglycerides (TGs) are a type of lipid carried in our blood. High levels contribute to the narrowing of our arteries.
- Non-high-density Lipoprotein (non-HDL) is your total cholesterol minus HDL cholesterol. That is all the bad cholesterol including the LDL.
There is a very important relationship between all four of them when checking cholesterol levels.
High levels of non-HDL or LDL and /or triglyceride with low levels of HDL may increase our risk of a heart attack and stroke.
What is normal levels?
Most people would assume that high cholesterol means being overweight. You could look slim and still struggle with your levels. Cholesterol builds up over time and if you’ve never had a ‘’lipid profile’’ test done, you may never know until after a heart attack or stroke. If I’m allowed to, I would call high cholesterol levels a ‘silent killer’.
Normal cholesterol levels are shown in the table below:
|Males: above 1.0
Females: above 1.2
|TC: HDL RATIO
|The lower the better
Above 6 is high risk
|2.3 or below (non fasting)
1.7 or below (fasting)
What factors increase our cholesterol levels?
- Age: As we get older, there is the tendency for our cholesterol levels to become elevated, the reason for this is not fully understood although LDL receptor activity decreases as we age which will increase LDL circulation, as less LDL is absorbed by the cells, but age is not an isolated variable, an addition of one or more of the other factors increases the risk.
- Sex: Men are at a higher risk than women. Although people may have the same cholesterol levels, their individual risk of cardiovascular disease is very different. Being a biological male is one of those factors that science doesn’t have a definite explanation for why yet.
- Ethnicity: Most people of South Asian and African descent are at higher risk. Although researchers have identified disparities between racial and ethnic groups, they are unsure how to interpret their findings. Dr Rajendra Mehta, a cardiologist at Duke University Medical Centre, says “There has to be something else going on that we don’t fully understand”.
- Genes: Inheriting a family faulty gene called (FH) familial hypercholesterolemia.
- Health status: Someone who has liver disease, kidney disease, type 2 diabetes, underactive thyroid, growth hormone deficiency, and/ or is overweight has a high-risk factor for elevated cholesterol.
- Your diet (more on this below)
Numerous scientific studies have shown that eating certain foods that are high in saturated and trans fats (unhealthy fats) increases our risk of elevated cholesterol. Having less or swapping these foods for those with mono and polyunsaturated fats (healthy fats) will help us to maintain healthy cholesterol levels. The table below briefly differentiates these fats and shows you the foods in which they are found:
|Types of fats
|Types of foods
|Avocado, olives, olive oil, rapeseed oil, almonds, cashews, hazelnuts, peanuts, pumpkin and sesame seeds.
|Processed meat like sausages and burgers, whole milk, lard, cream, butter, coconut oil, palm oil, and ghee.
|Fried foods, takeaways, certain biscuits and cakes and pastries.
|Fried foods, takeaways, certain biscuits and cakes, and pastries.
Food that lowers cholesterol
Below are some examples of foods that are good for lowering our cholesterol levels.
Numerous studies have indicated that whole grains such as oats, rye, and barley can reduce cholesterol levels due to the presence of beta-glucan, a type of soluble fiber. It is not only the fiber in whole grains that’s good for us, it seems to be the complete package of nutrients working together that’s beneficial.
- Apples and Avocados
A recent randomized trial showed that eating two apples a day helps to lower serum cholesterol. Another study suggests that the inclusion of one avocado per day may also help lower LDL since it is rich in monounsaturated fats.
A study of 26 RCTs showed that a dietary pulse intake at a median dose of 130 g/d (about 1 serving daily) significantly lowered LDL cholesterol levels compared with the control diets. Pulses are edible dry peas, beans, lentils, and chickpeas.
Okra also known as ladies’ fingers is rich in mucilage (the slime-like texture), a soluble fiber that binds cholesterol during digestion and promotes its passage via our stools (Habtamu Fekadu Gemede, 2014).
A meta-analysis of 46 controlled trials found that soybeans and their products (tofu, soy milk, soy yogurt) decreased circulating LDL and total cholesterol concentrations in adults by 3-4% (Sonia Blanco Mejia, 2019). The limited evidence that exists is only linked to eating at least 25g of soy protein a day which is an excessive amount. However, due to the many health benefits of soy, it may be a good idea to substitute animal-derived protein, including eggs in your diet for soy instead.
- Stanols and Sterols
Stanols and Sterols are plant cholesterol-like compounds also known as phytosterols. They have a similar molecular structure to cholesterol, which is why they can block the absorption of cholesterol into our bloodstream. The National Cholesterol Education Programme recommends about 2g of sterol and stanol per day to help lower cholesterol levels. Studies show that having enough sterols and stanols in our diet can lower total cholesterol by 10% and LDL by up to 14%. They occur naturally in small amounts in foods like fruits, veggies, vegetable oils, nuts, seeds, and grains. How can we reach 2g a day?
|You can achieve 2g per day of plant stanol and sterol by consuming:
One plant stanol or sterol fortified mini yogurt drink (one bottle) or yogurt (one pot) per day which contains 2g OR 2 -3 portions of foods with at least 0.8g of added plant sterol/stanol per day such as:
-Two teaspoons (10g) fortified spread
-One fortified yogurt
-One glass (250ml) fortified milk
Source: BDA Stanols and Sterols
- Amla (Indian gooseberries)
There is tons of medical literature on the health benefits associated with this humble fruit but for this topic, I will focus on its effect on cholesterol levels. However, you may be asking yourself what is Amla?
Amla is an ancient fruit tree that grows natively in parts of Asia. It has several culinary and herbal medicine uses, particularly in its native India. The fruit is rich in vitamin C and is often reported to have potential antioxidant and heart-health benefits.
A study on the effect of Amla supplementation in the diet of 35-55-year-old males with normal cholesterol levels versus those with high cholesterol. After 28 days of receiving the supplements, both categories recorded a decrease in total cholesterol. Two weeks after stopping the supplement, the triglyceride levels of the group with high cholesterol rose significantly again.
Gopa at al 2012 evaluated the efficacy of Amla verse simvastatin. The findings showed that Amla produced a significant hypolipidemic (lipid-lowering) effect.
With all that has been said, it is worth knowing that keeping a well-balanced variety in our diet, making healthy dietary choices, increasing physical activities, giving up smoking, and reducing alcohol intake to the recommended 14 units per week (that’s if you must drink), will work together in improving our overall health status and help reduce our risk of high cholesterol.
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Athanasios Koutsos, S. R. ( 2019). Two apples a day lower serum cholesterol and improve cardiometabolic biomarkers in mildly hypercholesterolemic adults: a randomized, controlled, crossover trial. The American Journal of Clinical Nutrition, 307–318.
British Dietetic Associoaton (BDA), Stanols and Sterols. Available at: https://www.bda.uk.com/resource/food-facts-plant-stanols-and-sterols.html
Biswas Gopa, J. B. (2012). A comparative clinical study of hypolipidemic efficacy of Amla (Emblica officinalis) with 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor simvastatin. Indian Journal of pharmacology, 238–242.
Ha V, Sievenpiper JL, de Souza RJ, Jayalath VH, Mirrahimi A, Agarwal A, Chiavaroli L, Mejia SB, Sacks FM, Di Buono M, Bernstein AM, Leiter LA, Kris-Etherton PM, Vuksan V, Bazinet RP, Josse RG, Beyene J, Kendall CW, Jenkins DJ. Effect of dietary pulse intake on established therapeutic lipid targets for cardiovascular risk reduction: a systematic review and meta-analysis of randomized controlled trials. CMAJ. 2014 May 13;186(8):E252-62. doi: 10.1503/cmaj.131727. Epub 2014 Apr 7. PMID: 24710915; PMCID: PMC4016088.
Habtamu Fekadu Gemede, N. R. (2014). Nutritional Quality and Health Benefits of Okra (Abelmoschus). Global Journals Inc. (USA), 1-11.
Jacob A, P. M. (1988). Effect of the Indian gooseberry (amla) on serum cholesterol levels in men aged 35-55 years. Eur J Clin Nutr, 939-44.
Soliman, G. A. (2019). Dietary Fiber, Atherosclerosis, and Cardiovascular Disease. Nutrients, 1155.
Sonia Blanco Mejia, M. M.-E. (2019). A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults. The Journal of Nutrition, 968–981.