Episode 147 – Nutrition for Reducing Cholesterol

Key Topics Covered

We are going to go with some general information such as HDL being ‘good cholesterol’, LDL being ‘bad cholesterol’ and the goal is to reduce LDL cholesterol and triglycerides.
It’s important to note that genetics, diet, exercise and other lifestyle factors can play a role.
If you spend time consuming nutrition content, you will come across some mixed views on cholesterol.
The goal of this episode to to keep things simple and go through strategies that can help reduce cholesterol, with the assumption that it will help reduce your risk of cardiovascular issues from arising.

Plant Sterols

Plant sterols are the easiest of easy wins.
You can simply take a supplement and it reduces LDL cholesterol.
Based on the research, decreases in the range of 6-12% are to be expected, assuming your cholesterol was high at the baseline.
We do consume plant sterols through food. One issue though is that the amount is is difficult to actually quantify.
One thing we know for sure though is that research typically seems to find benefits up to around 3g dosage per day. This would indicate that most people do not consume enough through food to optimise things, otherwise adding the supplement wouldn’t be effective.
In Australia there are various products containing this including cholesterol lowering weet-bix, heart active milk and flora proactiv.

Getting Leaner

Losing body fat typically helps.
Something that stands out to me is that almost every study I have ever read where participants have lost >5% of body weight on average, LDL cholesterol has dropped on average.
That doesn’t mean EVERY individual in those studies has experienced a reduction, this is just referring to averages.
Dietary quality can influence cholesterol of course. But another thing that stands out is that there are many examples of mediterranean diet studies where cholesterol remains unchanged even with huge improvements in dietary quality (example is SMILEs trial).
The mediterranean diet has been shown though to consistently reduce the risk of cardiovascular disease regardless.
Meanwhile there are exceptions where people experience increases in cholesterol while getting leaner. Often if they are using exceptionally high saturated fat approaches.

Saturated & Trans Fat

Trans fats are clearly linked to cardiovascular disease and adverse outcomes. I don’t think I’ve ever seen anybody debate that.
Saturated fat is more complex and not as clear cut as you’d think. For example, a meta-analysis on saturated fat and cardiovascular disease risk that found no increased risk.
On the other hand, tightly controlled studies do tend to find a link between saturated fat and LDL cholesterol on average.
If you are interested in learning more about this, there’s a dense article from Sigma Nutrition below that covers this extensively.
Overall though, if your goal is to reduce cholesterol, it’d make sense to reduce your intake of saturated fat.

Healthy Fats

Research looking at replacing saturated fat with monounsaturated or polyunsaturated fat has found reductions in LDL cholesterol.

Omega 3

Omega 3 supplementation has strong evidence for helping reduce triglycerides
It’s less positive for reducing LDL cholesterol.
But this has other applications e.g. if you happened to just have high triglycerides, this could be really impactful.
High-ish dosages of >850mg combined EPA and DHA seem to be most effective.

Dietary Cholesterol

There are two massive pendulum swings most people in the nutrition space make here:
One is that dietary cholesterol is really bad and needs to be avoided where possible.
The other is that dietary cholesterol barely effects our blood cholesterol.
The answer is somewhat in the middle.
This is partly why you see large health bodies struggle with questions like “should you avoid eggs if you have high cholesterol”.

Mechanisms

A large percentage of the cholesterol in our blood is actually produced in our own body. But there can be exceptions e.g. if you had a significant amount of dietary cholesterol, that can change.
Another aspect is that most sources of dietary cholesterol are also high in saturated fat and calories in general.
Dietary cholesterol is one piece of the puzzle, but outside of extremes, it is less important than a lot of other variables.

Soluble fibre

Increasing soluble fibre intake consistently reduces cholesterol.
I’d typically go with a food first approach, however simply supplementing with metamucil, which is based on psyllium husk, has been found to reduce LDL cholesterol by 6-24%.
One aspect is that the gel like substance that soluble fibre forms theoretically traps cholesterol.
But fibre in general, whether soluble or not could also indirectly affect things through reducing appetite and calorie intake too.

Summary

Nutrition interventions that can be helpful fo reducing cholesterol include:

Including plant sterols (as either fortified foods or in supplementation form).
Fat loss if you are carrying excess body fat.
Reducing saturated fat and trans fats and replacing them with monounsaturated or polyunsaturated where relevant.
Having a good intake of omega 3 – particularly if triglycerides are the main goal.
Having awareness that dietary cholesterol isn’t the be all and end all, but that it still matters.
Having a high fibre intake, including foods such as psyllium husk for soluble fibre specifically.

Relevant Blogs / Resources

Blog Posts:

Studies: