Leah:

Hello and welcome to the Ideal Nutrition Podcast. I’m Leah Higl and I’m here with my co-host Aidan Muir and today’s episode will be all about nutrition for reducing cholesterol. So cholesterol is a little bit of a minefield in that it is a complex topic. But we’re going to go in with the basic assumption about things like HDL cholesterol is good cholesterol, LDL cholesterol is bad cholesterol and the goal overall is to reduce the LDL cholesterol and triglycerides.

So there is a lot that can play into this from a nutrition point of view. Diet, exercise, as well as other lifestyle factors are all part of this discussion, but it’s also important to note that genetics can play a large role as well. Basically, we want to keep it super simple. If you spend time-consuming nutrition content, you’ll probably come across a lot of mixed opinions and views on cholesterol.

And that could be a separate podcast all on its own. But basically the goal of this particular podcast is simply to go through the different kinds of strategies that you could potentially implement to overall reduce your cholesterol with the assumption that that will also help to reduce the risk of cardiovascular disease.

Aidan:

When it comes to LDL cholesterol, plant sterols are the easiest of easy wins. I’m normally a pretty food-first type of person, but you can simply take a plant-serum supplement in a certain dosage, and on average, it reduces LDL cholesterol by 6 to 12% in as little as about six weeks, assuming you have high LDL cholesterol to start with. This applies to various forms of reasons why your LDL cholesterol could be high.

Research has been done on this with people with genetic high cholesterol, so familial hypercholesterolemia, which is what it’s typically called. Even in those cases, we see similar levels of reduction. So it’s a really easy win. I say I’m food first. And one of the obvious questions I looked at is, can we get this through food? Like anytime I look at supplementing anything, I’m like, is it possible to get this through food? Is it realistic? And I try to make a comparison based off of that. With plant sterols, it is really hard for us to actually find how much is in certain foods.

I’ve looked, it’s been a little while since I’ve looked, but when I looked, I could not find anything that was a reliable indicator being like, this food has this amount of plant sterols or anything like that. So we kind of have to make some assumptions. One of the clear things is that based on research, typically going above around three grams of plant sterols per day, people do not see further improvements. It seems to cap out about there. And if you just get a random population of people with high cholesterol and you give them two to three grams of plant sterols, we typically see these six to 12% improvements. So we know.

The appropriate dosage typically seems to be two to three grams. Going above that doesn’t have any further benefit, which kind of tells you that most people in these populations are not getting enough through food. It’s hard to tell if somebody is getting enough through food, but it’s pretty clear that on average most people would have a quote on quote suboptimal intake of these plant cereals. So that’s why it’s a very easy win. In Australia, the form that most people would be familiar with is certain fortified foods.

So we have flora proactive, which is probably the most popular one. We have cholesterol-lowering weetbix, there’s heart-active milk. Carmans have recently brought out a muesli, I believe, that has plant sterols as well. There’s a few other popular products like that. The next obvious question based on that is why are so many foods just fortified with this? One of the things that I believe was particularly believed early on is that these would just be more effective if paired with food to start off with. For example, why is it typically used in margarine was maybe the logic that if it’s absorbed alongside some fat, it might be more effectively absorbed, but researchers looking at supplementation just using a capsule has shown just as good results. And I actually prefer using the supplements instead of the foods that have been fortified with this just because you don’t have to now be reliant on hitting that dosage.

For example, Flora Proactive requires you to have 20 grams per day to get that around two to three grams of plant serums. 20 grams of margarine is probably more than I’m recommending to most people. I don’t want to Yeah, 20 grams is a fair amount, right? Yeah, I don’t want to be making people have more of something than they necessarily want to just to these ones. Like, we could just have a supplement. So that’s the easiest of easy wins.

Leah:

Another strategy we could potentially think about, particularly if you’re carrying excess body fat, is losing some body fat. Something that stands out to us is that in almost every study that we’ve read on this particular topic where participants have lost over 5% of body weight on average, LDL cholesterol has also dropped alongside that body fat reduction. That doesn’t mean every individual in those studies has experienced a reduction in cholesterol from a weight drop, but this is just referring to averages. So we know on average, it does seem to impact LDL cholesterol in a positive way.

Dietary quality can also influence cholesterol. So it’s not all about weight loss. But another thing that stands out here is that there are a bunch of like Mediterranean diet studies where cholesterol remains unchanged, even with huge improvements in overall dietary quality, but not necessarily seeing a huge reduction in body weight. Another example is the SMILES trial where we also kind of see this occurring.

That being said, it’s a bit of a red herring since the Mediterranean diet has been shown to consistently reduce the risk of cardiovascular disease regardless. So when we’re thinking reductions in LDL cholesterol and triglycerides, like ultimately that is to reduce the risk of heart disease. But it seems like with something like the Mediterranean style diet, they’re not seeing these huge changes in cholesterol, but they are seeing improved health outcomes in regards to reduce risk of cardiovascular disease.

Meanwhile, there are exceptions where people experience increase in cholesterol while getting leaner, but often it’s because they are taking an approach that increases the saturated fat. So it could be that maybe they are getting leaner from their approach, but maybe it’s something like the carnivore diet where they have a really high intake of saturated fat.

Aidan:

Yeah, personally, just anecdotally from what I’ve seen, only times I’ve really seen that where there has been where people have gotten significantly leaner and the LDL has increased is carnivore slash ketogenic type situations. That doesn’t mean there are no situations where it has outside of that. That’s just the most common thing that I see.

Now talking about saturated fat and trans fat. Trans fat is clearly linked with cardiovascular disease and just adverse outcomes in general. I don’t think I’ve seen anybody ever debate that. Have you ever seen anyone debate I don’t think I have, no. I think that’s pretty clear, One of the few universally agreed upon things in nutrition.

Saturated fat is more complex and not as clear cut as you’d think. For example, in the show notes of this, I’ve linked a meta analysis on saturated fat and cardiovascular disease risk that found no increased risk of cardiovascular disease. Tightly controlled studies do tend to find a link between saturated fat and LDL cholesterol on average. Something that makes this a complex topic is you will find people who will try to debate this point, which is why I come back to that tightly controlled things. An example that is super commonly used in the nutrition space is what I tend to call like narrative driven arguments, like something that I often see is people would be like, Ansel Keys did a study in the 70s, don’t quote me on the 70s, but like, did a study, there’s a seven country study, and he messed with the data to make it show that saturated fat was linked with cardiovascular disease or increased LDL.

I’m no Ansel Keys expert, but the narrative like driven thing is often just being like, this one person, Ansel Keys, did this, it led to this finding and then everybody just followed him like sheep and everybody believes that saturated fat leads to cardiovascular disease. One thing that I like to touch on with that is that’s kind of offensive. It’s kind of offensive to anyone who is in this space who is really trying really hard to get good answers to tough questions about how they can help people to the best of their ability. And there are very smart people who would not just be fooled by one person messing with some data like there’s so much research on saturated fat.

There’s so much research, there’s so much modern research. We’re in 2024, like do we really think that what happened in, for example, the 70s or 50s or whatever has just shaped how we all view things in 2024? I just wanted to touch on that narrative driven approach. If you are super keen to learn more about this, there is a really dense article from Sigma Nutrition in the show notes that covers this topic better than anything else I’ve ever seen. It goes through this in so, so much detail.

I believe from memory it even includes a bunch of that stuff on Ansel Keys because I’m no expert on his specific like wrongdoings, et cetera. Because I don’t think it matters when they’ve got so much research these days. But the short version is I wouldn’t overthink this. If you got this reduced cholesterol, it does make sense to reduce saturated fat, even if it’s not the be-all and end-all.

Leah:

Yeah, and it’s not that you have to reduce your overall fat intake either. It could just be looking at reducing your overall saturated fat intake and then introducing more mono and polyunsaturated fats. And that in general has been found to reduce LDL cholesterol.

Aidan:

That is a very huge point because how I touched on that meta analysis earlier that did not find a link between saturated fat and cardiovascular disease. The big question is always what are you replacing it with? This is a criticism that a lot of people say that’s like, if you replace saturated fat with, quote unquote, refined carbohydrate, is it going to reduce the cardiovascular disease? What if you replace it with extra virgin olive oil, are your odds suddenly improved? Like there’s so many ways you can look at this. This applies to a lot of nutrition research as well.

On that topic of healthy fats, the first one that comes to mind for a lot of people would be omega -3s and being like, how does this impact this? Omega-3s have really good research. It’s really strong evidence for helping to reduce triglycerides. It’s less positive for LDL cholesterol, just doesn’t seem to make much difference there, but for triglycerides, very clear research showing that it helps with that if sufficient dosages are used.

This can have some pretty interesting applications like if you looked at a random meta -analysis of Omega 3 and cardiovascular disease, often you do not find that much of a positive outcome. There have been so many different meta -analyses that have looked at this through different lenses from different angles, but one angle you can look at this from, and it has been done, is one of the most clear-cut ones, is if certain people have had a cardiovascular event, they are on statins, which are very good at reducing LDL cholesterol, but not as good at reducing triglycerides.

Then they give them really high dosages of fish oil or omega-3. Sometimes they do really high dosages of prescription only EPA, which is a form of omega-3. We then see reductions in cardiovascular disease risk. There’s a very niche angle to go, but I like to point it out being like there are some pretty niche applications of this. The high-ish dosages that we’re typically looking at are greater than 850 milligrams of combined EPA and DHA. That’s what seems to be most effective. But some of these studies are using quite high dosages of just EPA and they’re showing these kind of benefits.

Leah:

The next strategy we’ll touch on is looking at overall dietary cholesterol. So there are two massive pendulum swings in this space and people go from being like either dietary cholesterol is really bad for you and increases your blood cholesterol and needs to be avoided wherever possible all the way to dietary cholesterol doesn’t impact blood cholesterol whatsoever. So you definitely have two camps of people, but the reality does seem to sit somewhere in the middle. This is partly why you see a lot of large health bodies struggle with questions like, should you avoid eggs if you have high cholesterol? It’s because like, well, maybe it’s not the biggest thing to think about, but maybe it still matters a bit.

So a large percentage of the cholesterol in our blood is actually produced by our own body, but there can absolutely be exceptions, particularly if we have heaps of dietary cholesterol coming in through what we’re doing nutritionally, then obviously we see changes there. Another aspect is that most sources of dietary cholesterol are also pretty high in things like saturated fat and calories in general. So it’s hard to isolate the dietary cholesterol you know, on its own. So overall, dietary cholesterol is just one piece of a pretty big puzzle and outside of extreme circumstances, it’s probably less important than the other variables, but potentially something to consider.

Aidan:

The whole thing about how it’s difficult to isolate also applies to an earlier where we talking about when some people have gotten leaner and their LDL cholesterol has shot up massively. Because often they say they’re doing high saturated fat, they’re also doing high dietary cholesterol. Which one was the biggest driving force? Kind of hard to say.

The next one we’ll go through is soluble fibre. So increasing soluble fibre intake consistently reduces cholesterol in research. So that’s really good information. It’s a really easy one to practically apply. I typically would like to go with a food-first approach once again. It’s hard to communicate this, but soluble fibre typically doesn’t often come by itself. If you just focus on increasing your fibre intake in general, you probably increase your soluble fibre.

in the process. I’ll talk a little bit more about fiber in general as to why I haven’t really specified insoluble fiber as well. But I want to add some stats to kind of make this interesting. Because it’s one thing to be like, I’ll increase fiber intake, but let’s make this more interesting. There’s research looking at simply supplementing with Metamucil, which is based on psyllium husk. And it was found to reduce cholesterol by or LDL cholesterol specifically by six to 24%. That moves the needle. You heard me get hyped up before about plant sterols where we’re looking at like a six to 12% reduction.

Metamucil supplementation outperforms that. The logic is that soluble fibre specifically, psyllium husk in that case as well, it can form a bit of a gel-like substance that can trap cholesterol. That is kind of the logic there and help it kind of get out of the blood. But fibre in general, whether soluble or not, can also indirectly affect things because it could reduce your appetite or satiate you a little bit more and that could reduce your calorie intake as well. So even going back to that Metamucil thing,

would people’s calorie intake have changed because they were having Metamucil? It’s hard to be like how much of it is due to this gel-like substance trap in cholesterol and how much of it is due to actual changes in dietary intake due to the fiber helping of appetite, which is why, although I’m specifying soluble fibre, I just think increasing fibre in general should play a role.

Leah:

In summary, nutrition interventions that can be helpful for reducing cholesterol include things like including plant sterols, whether that’s as fortified foods or in supplement form, both are beneficial. Fat loss, if you are carrying excess body fat, obviously can be beneficial. And then also doing things like reducing saturated and trans fats and replacing those with healthy fat options like mono unsaturated and polyunsaturated fats.

You could look into supplementing omega-3, particularly if reducing your triglycerides is a predominant goal for you. Having an awareness of dietary cholesterol is a good idea. It’s not the be-all and end-all, but it’s still important to not have an excessively high intake of dietary cholesterol. And then finishing up with having an overall high-fibre diet and maybe thinking about doing something like your soluble fibre supplements like Metamucil or psyllium.

Aidan:

This has been episode 147 of the Ideal Nutrition Podcast. As always, if you have not already, if you could please leave a rating and a review, we would massively appreciate that.