Many people think of cholesterol as a villain that damages the arteries. The truth is that we need this waxy, fat-like substance because it helps to form the myelin layer that insulates nerves. A certain form of cholesterol on the skin is converted into vitamin D by the sunshine. Without cholesterol, your body couldn’t make sex hormones or the anti-inflammatory hormone, cortisol, which would certainly pose many problems to your body, wouldn’t it?

The liver makes all the cholesterol we need so we do not need to obtain it from food sources.  It travels through the blood in specialized packages called lipoproteins.  The level of cholesterol, how it is packaged, the distribution of fat, cholesterol and protein in the lipoproteins, and whether or not it has been oxidized, determines whether or not cholesterol is damaging to the body.

VILIFYING CHOLESTEROL: LDL

Cholesterol is packaged in several different lipoproteins.  Cholesterol, which belongs to the lipid family and is not dissolvable in water, must be combined with protein in order to travel within the blood.  LDL (low-density lipoprotein) carries cholesterol to the cells and arteries.  As LDL levels rise, the risk for cardiovascular events, like coronary artery disease and stroke, increases in a dose-related fashion.  For this reason LDL is commonly referred to as "the bad cholesterol". In reality we do need some LDL, but we don’t want it to reach levels where it builds up in our arteries.  If more LDL is present in the blood than can be removed, then it accumulates in the arteries and produces chemical signals that attract white blood cells. The migrating white blood cells are unable to eat oxidized cholesterol, and the inflammatory process that follows results in further plaque formation and hardening of the arteries. The goal is to get LDL levels below 130 milligrams per deciliter (mg/dl), then 100, and, for high-risk patients, down to between 100 mg/dl and 70 mg/dl,^₍₁₎ especially if other cardiovascular risk factors are present—obesity, smoking, diabetes, or hypertension.

REDUCING ELEVATED LDL

Some people have a genetic tendency to endogenously produce more cholesterol than others.  Saturated fats, animal protein, and junk foods raise this so-called "bad cholesterol".  Vegetarian diets low in fat or saturated fat have been used successfully as part of a comprehensive health program to reverse severe coronary artery disease.^{(2), (3)} Not only is mortality from coronary artery disease lower in vegetarians than in nonvegetarians,⁽⁴⁾ but vegetarian diets have also been successful in preventing, arresting, and even reversing coronary artery disease and other cardiovascular diseases when combined with regular exercise and stress management strategies.^{(5), (6), (7), (8), (9), (10), (11)} Total serum cholesterol and LDL cholesterol levels are usually lower in vegetarians. Vegetarians tend to have a lower incidence of hypertension than nonvegetarians.⁽¹²⁾ This effect appears to be independent of both body weight and sodium intake.

Nutrition professor Winston Craig of Andrews University states that "Following a vegetarian diet results in a significantly lower blood cholesterol level, since a vegetarian diet contains less saturated fat and more fiber and phytochemicals."⁽¹³⁾

Both observational and experimental studies confirm that vegetarians and vegans have lower levels of both total serum and LDL cholesterol.  David Jenkins and colleagues of the University of Toronto documented that a diet that emphasizes viscous fibers, plant sterols, soy protein, and nuts, reduced LDL cholesterol by approximately 30% and produced clinically significant reductions in CHD risk.^{(14), (15)}

By studying data collected from 4,466 subjects in the National Heart, Lung, and Blood Institute Family Heart, researchers at Boston University School of Medicine investigated the effect of fruit and vegetable consumption on LDL cholesterol.  They discovered that fruit and vegetable consumption was inversely related and that this association was observed across categories of age, education, smoking status, and physical activity.  In this study, exclusion of subjects with diabetes mellitus or coronary artery disease did not alter these results significantly.⁽¹⁶⁾ Why is this?  There is no dietary cholesterol in plant foods and only a small amount of saturated fat.  Legumes are especially useful in lowering cholesterol levels, improving blood sugar, and reducing blood fats called triglycerides.  Researchers at Arizona State University found that just the recommended amount of beans – one-half cup daily – lowered cholesterol by about eight percent, which lowers heart disease risk by 16%.⁽¹⁷⁾ Legumes are also rich in soluble fiber, which promotes the excretion of cholesterol and plant sterols that block cholesterol absorption.  Other components of a vegetarian diet also protect from cardiovascular disease, as we shall see later.

OXIDIZED CHOLESTEROL

Cholesterol exposed to the air over a period of time tends to combine with oxygen, producing oxidized cholesterol.  Of course, oxidation can also occur within the body.  LDL becomes especially dangerous when it becomes oxidized because oxidized cholesterol kills the smooth muscle cells that compose the medial layer of the arteries and also promotes inflammation inside the arteries.

Many studies have demonstrated that the following practices can reduce total cholesterol and LDL if consistently practiced:

1. Eliminate food sources of oxidized cholesterol.  Aged cheese, custard and puddings, and powdered milk and egg products all contain oxidized cholesterol that the body does not need.  Dietary items that combine sugar, milk, and eggs are the worst offenders when it comes to oxidized cholesterol.

2. Eliminate meat and aged cheese: eliminate or seriously restrict eggs and milk.  Both saturated fat from animal products and animal protein can elevate cholesterol levels.

3. Avoid hydrogenated fats.  Trans fats, found in hydrogenated oils, increase both total and LDL cholesterol.

4. Regularly enjoy foods rich in antioxidants - berries, grapes, apples, dark green, leafy vegetables and other deeply colorful vegetarian foods.  Antioxidants help to protect cholesterol from the oxidation that naturally occurs in the body.⁽¹⁸⁾

5. Eat foods rich in plant sterols and stanols.  Because they chemically resemble the structure of cholesterol, these block cholesterol absorption.  Many fruits, vegetables, whole grains, and nuts have small amounts of these important phytochemicals.  Supplements containing plant sterols are commonly sold in health food stores.  Other studies have shown a 10-14% reduction in LDL cholesterol without side effects at intakes of 2 to 2.5 grams sterols/stanols per day.(19), (20), (21)

6. Researchers have found that phytochemicals in artichokes,⁽²²⁾ garlic,⁽²³⁾ ginger,⁽²⁴⁾ turmeric,⁽²⁵⁾ soybeans,⁽²⁶⁾ resveratrol⁽²⁷⁾ in blueberries and red grapes, strawberries,⁽²⁸⁾ cranberries,⁽²⁹⁾ and apples⁽³⁰⁾ actually inhibit the oxidation of LDL cholesterol.  Pomegranates give greater protection against LDL oxidation than red wine.⁽³¹⁾ Fruits, such as strawberries, cranberries, apples, artichoke leaf juice, and soy beans also inhibit cholesterol synthesis. Flaxseed slows down the progression of already developed atherosclerosis.⁽³²⁾ We should also mention that artichoke and soybeans improve the ability of the arteries to dilate, as well.

7. Strive to reach and maintain your ideal weight.  The body can convert extra food—even from vegetarian sources—into extra cholesterol as well as fat.

8. Consuming nuts 4-5 times a week is associated with a 50% reduction of coronary event risk, and consumption of whole grain bread is associated with a 30% lower risk of these events.⁽³³⁾ Not only do walnuts contain anti-oxidants and anti-inflammatory phytochemicals, consuming them daily can decrease total and LDL cholesterol more than daily consumption of fish in individuals with elevated cholesterol or triglycerides.⁽³⁴⁾ Daily consumption of walnuts lowers the bad cholesterol (LDL), but raises HDL in diabetic individuals.  Both walnuts and olives preserve the endothelial functioning of the blood vessels after a person consumes a high fat meal.⁽³⁵⁾ Spanish researchers in a randomized, cross-over study found that walnuts also improve the ability of the blood vessels to dilate in persons with elevated cholesterol compared to the Mediterranean diet.⁽³⁶⁾ This is important because elevated cholesterol eventually impairs the ability of the blood vessels to dilate.

THE WORST LDL

Small, dense LDL particles are the very worst kind of cholesterol because they penetrate the arterial wall faster and linger longer inside the arteries so that more damage is done.  They accelerate the process of atherosclerosis.  Obesity, diabetes, and elevated triglyceride levels are associated with elevated LDL.  Reducing the intake of fast-burning carbohydrates (candy, sweets, soft drinks, and juice), increasing fiber intake, reducing body fat, eliminating trans fats, and exercising regularly all reduce the level of small, dense LDL particles.^{(37), (38)}

HDL: THE BENEFICIAL LIPOPROTEIN

Like LDL, HDL (High Density Lipoprotein) carries cholesterol and fats, but the difference with HDL is that it pulls cholesterol from the arteries and carries it to a different destination—the liver where it is converted into bile.  HDL also has less lipid content than LDL.  High levels of HDL are considered protective against coronary artery disease and stroke. Acting as scavengers, HDL particles actually take away cholesterol from arterial walls before it becomes hardened into plaque.  HDL also protects LDL from being oxidized and under normal conditions is anti-inflammatory.  Risk of heart attack declines one to three percent for every one percent increase in HDL.⁽³⁹⁾ Many scientific studies show that regular aerobic exercise and losing weight, if one is obese, elevate the "good cholesterol."  Actually, just a 10% weight loss within six months in post-menopausal women increased their HDL by nine percent and improved their ability to utilize glucose more efficiently.⁽⁴⁰⁾

Alpha-linolenic acid supplementation for twelve weeks improves HDL levels and reduces diastolic blood pressure.⁽⁴¹⁾ Alpha-linolenic acid is found in flaxseed, spinach, and soybeans.  Olives raise HDL and help to reduce the risk for undesirable clotting.⁽⁴²⁾ Evening primrose oil is another fat that can not only lower cholesterol levels, but boosts HDL and increases prostacyclin, a chemical that discourages undesirable clotting.⁽⁴³⁾ Chromium, time-released niacin, and folic acid also elevate this beneficial lipoprotein.⁽⁴⁴⁾

Replacing white bread and other refined carbohydrates with whole grains helps to improve blood sugar control in young individuals.⁽⁴⁵⁾ Good blood sugar control is an important predictor of HDL in youth.  Even a high-normal level of blood sugar, especially when accompanied by obesity or high blood pressure, increases the risk of cardiovascular damage.  Just one meal of high fat foods significantly constricts the arteries, which is especially dangerous to anyone with elevated cholesterol or triglyceride levels or high blood pressure.  Find a healthy alternative to the baked goods containing hydrogenated fat that inevitably contains trans fat, and you will have better health.

So lifestyle modifications as well as genetics shape our lipoprotein profiles.  Of course, there are those individuals who are at high risk for coronary artery disease or stroke, and these individuals need appropriate medical treatment with the lifestyle changes we have mentioned here.  However, many individuals with elevated cholesterol levels can lower their risk just by following the above lifestyle interventions.

BEYOND CHOLESTEROL

Cholesterol is not the entire story, though.  Atherosclerosis is largely an inflammatory disease.  Inflammation significantly compromises the ability of the arteries to dilate.  Unfortunately, the same lifestyle factors that increase cholesterol levels usually increase inflammation in the body.  Obesity, especially extra pot-belly fat, revs up the machinery of inflammation in the entire body, including the arteries.  The same lifestyle program that lowers elevated cholesterol and LDL levels and increases the beneficial HDL also reduces inflammation.  There is more good news.  Israeli investigators have shown that obese persons who experienced moderate weight loss, induced by nutritional and exercise intervention, improved small and large artery elasticity, improved their glucose control, and reduced pro-clotting and inflammatory agents in the body as well.⁽⁴⁶⁾ Moderate daily exercise, sufficient sleep, and a positive mental outlook reduce the risk for cardiovascular disease and decrease the risk for inflammation and undesirable clotting as well.⁽⁴⁷⁾

LIFE APPLICATION: DESTINATION OF WORDS
 
The distribution of fat, protein, and cholesterol varies with HDL and LDL cholesterol. HDL has more protein and less cholesterol and fat than LDL.  This is important.  The way lipoproteins are packaged and how their individual components are distributed determines their destination.  Likewise, we package our thoughts in words, sentences and paragraphs, but our stance, our tone, our eyes, and body language communicate volumes more than merely our choice of words.  In his treatise on communication, Solomon observed that the manner in which we package our words will determine their destination—either for good or for ill.

• "A man has joy by the answer of his mouth: and a word spoken in due season, how good is it!" Proverbs 15:23
• "The contentions of a wife are a continual dropping." Proverbs 19:13
• "He that passes by, and meddles with strife belonging not to him, is like one that takes a dog by the ears." Proverbs 26:17
• "Righteous lips are the delight of kings; and they love him that speaks right."  Proverbs 16:13
• "A soft answer turns away wrath: but grievous words stir up anger." Proverbs 15:1
• "The sweetness of the lips increases learning." Proverbs 16:21

This article has been excerpted from the CD book, Keys to Optimal Health and Happiness and is available from Wildwood’s Herb Shop. Copyright 2009. All rights reserved. If you enjoyed this article, you will be interested in lifestyle physiology offered by the College of Health Evangelism. Visit www.healthevangelism.com/online for samples of health classes offered.

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