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The reason to lower cholesterol is primarily to provide protection from heart
disease; some other things that can be done to protect from coronary heart
disease include:
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Get regular cardiovascular exercise. This will protect your heart at any
level of cholesterol - and may incidentally also help to raise your HDL
cholesterol. (The point is not primarily the effect on cholesterol; but the
effect on heart disease risk, which is the reason for caring about cholesterol.)
Exercise protects against many things -- such as heart disease, diabetes,
hypertension, cancer, stroke, peripheral arterial disease, osteoporosis, sleep
disturbance, and depression. For this reason, if cholesterol lowering drugs are
limiting your ability to get exercise, the potential impact on health and
longevity should not be underestimated and must be considered in determining the
risk-benefit balance. (The impact on well-being and quality of life, including
ability to engage in activities of daily living, family life, social life, and
work life are also not to be dismissed.)
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Eat lots of fresh fruits and vegetables. A number of quite different "phytonutrients"
(substances in fruits and vegetables) have heart protective effects. Studies on
fruits ranging from grapes to pomegranates to orange juice have shown benefits
to the heart--and in the case of orange juice, benefits to HDL-cholesterol
values (with sufficient consumption). A study from Duke University found much
higher rates of nutrients in organic than commercially grown ones, so it may be
prudent to include organic in your repertoire.
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Consider eating two fatty fish meals a week. This will have little affect
on your cholesterol, but will likely reduce your risk of death from heart
attack. One study (the Diet and Reinfarction Trial or DART) showed that in men
with heart disease, advice to eat two fatty fish meals a week resulted in a 30%
reduction in overall mortality in 2-years -- as big an effect as has been shown
with use of statin drugs in men with heart disease (in the 4S study, which
showed the biggest effect on cardiac deaths of the major statin studies). In
contrast, a low-fat cholesterol-lowering diet in the DART study had no impact on
survival. These data from this "randomized controlled trial" parallel data from
the Framingham study, which showed a 30% reduction in coronary deaths in those
who ate two fish meals a week.
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Completely avoid
"trans hydrogenated fats." This is anything with the
words "margarine" or "shortening" in the ingredient list; and anything with the
word "hydrogenated". Do not be fooled by phrasing such as "All vegetable
shortening;" this may sound healthful, but evidence suggests it is more harmful
than butter or lard. Trans fats raise harmful LDL, lower levels of protective
HDL, and have the worst effect on the cholesterol-to-HDL ratio of any fats. They
may also interfere with essential fatty acid utilization. In one study comparing
several hundred men and women who had recently had a heart attack to control
subjects, 2.5 pats of margarine or more a day was linked to a several-fold
excess risk of heart attack, while butter consumption bore no relationship. In a
very large study that followed nurses across time, being in the top 25% of
margarine consumption in the population was associated with about a 50% increase
in heart attack risk. Examine labels of packaged/ purchased baked goods
carefully, since most will contain hydrogenated fats and you will need to
identify brands with "healthy" fats or no fats.
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Other dietary suggestions:
eat fresh nuts (evidence indicates
cholesterol benefits, heart-protective effects and also benefit to “insulin
resistance”); emphasize olive oil in cooking (monounsaturated fats raise HDL
cholesterol and may lower LDL cholesterol, improving the cholesterol ratio); and
consume garlic and perhaps onions in your diet, which may reduce cholesterol to
some degree. Chocolate (the kind made with cocoa butter, not trans-hydrogenated
fats) contains primarily “stearic acid,” a fatty acid that raises HDL without
raising LDL, so this need not necessarily be avoided from a cholesterol
standpoint. Studies have also reported benefits of moderate chocolate
consumption to heart disease. By now you are probably familiar with the pros
and cons of alcohol. If you do drink, the pattern that is most associated with
benefit is small amounts of meal associated alcohol. Large amounts consumed in a
non-meal associated pattern may be harmful to the heart, and increase “insulin
resistance” (a diabetes-predisposing condition).
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