IIn the years following World War II, doctors in the United States and Europe noticed a surprising phenomenon: rates of Heart attack And the brain attack It fell dramatically in many places. Autopsies in this period also revealed lower rates of atherosclerosis, the buildup of fatty arterial plaques that causes cardiovascular disease.
At first, the experts were puzzled. But over time, many have concluded that wartime food deprivation and forced changes in people’s diets — that is, big cuts in consumption of red meat and other animal products — have contributed to improved heart health. Subsequent work, notably the famous Framingham Heart Study, has helped establish that cholesterol levels, driven in large part by a person’s diet, tend to closely overlap with Cardiovascular disease.
The idea that the foods a person eats may increase or decrease their risk of unhealthy cholesterol levels and disease was, at first, radical and controversial. While there is an ongoing debate about the relationship between red meat and poor health, the links between diet, cholesterol and cardiovascular disease are beyond doubt.
Cholesterol is a waxy compound that your body uses primarily to produce hormones and strengthen cell walls. “Our body needs some cholesterol to perform its daily functions, but the amount the body needs is relatively small,” says Dr. Lawrence Sperling, founder and director of the Heart Disease Prevention Center at Emory University in Atlanta.
Various parts of the body, including the brain and blood, contain cholesterol. It’s precisely the increased amount of cholesterol in the blood that causes problems – particularly low-density lipoprotein (LDL), which is also known as “bad cholesterol.” Francine Welty, a cardiologist at Beth Israel Deaconess Medical Center in Boston and past chair of the American Heart Association’s Lipid Committee, explains that too much LDL in the arteries can “form a fatty streak, which is a precursor to atherosclerotic plaque.” Therefore, low-density lipoprotein is the building block of arterial plaque.
Both major diseases associated with occlusive arteries – coronary artery disease and cerebrovascular disease – are among the three leading causes of death worldwide. More than 1 in 4 deaths is caused by one of these two conditions, and managing or lowering cholesterol levels is a proven way to prevent these diseases. Ideal or “target” cholesterol levels vary depending on a person’s age, sex and health status, says Sperling. But, optimally, you want to keep your LDL cholesterol below 70 mg/dL. While drugs can help people get there – and in some cases may be necessary – he says non-pharmacological approaches are just as important. “Lifestyle and behavioral approaches are the foundation of cardiovascular disease prevention for everyone,” he says.
Here, experts detail the most impactful lifestyle changes that must be made to lower cholesterol. Everyone agrees that a proper diet tops the list.
How to eat to lower blood cholesterol
One of the biggest trends in diet and nutrition advice is to move away from talking about specific micronutrients and the optimal daily meals for this or that food group. Instead, nutritionists now talk a lot about broad patterns of healthy eating. This means limiting some foods while prioritizing others, rather than trying to reach narrow goals.
“One thing I say to many of my patients is that the Greek derivation of diet is diata, which means a way of life,” Sperling says. “Dieting doesn’t have to be torture, or something you keep for a month. It should be a purposeful, purposeful change that you can extend throughout your life.”
In that spirit, he says one of the most important changes you can make is to pack your meals with plenty of fresh fruits, vegetables, nuts, and whole grains. Many of the most effective and evidence-backed eating plans for lowering cholesterol – like Mediterranean diet—Prioritize these foods, he says.
Meanwhile, reducing the intake of animal products — particularly red meat and processed dairy — is a step that research has repeatedly linked to cholesterol improvements. “I’ve run a fat prevention clinic in my hospital for 31 years, and the first thing we tell people is to reduce their intake of saturated fat,” Welty says. You mentioned red meat, butter, and dairy as foods people should aim to reduce — not necessarily eliminate, but reduce — if they want to improve their cholesterol. Many Americans consume Saturated fatFrom eggs and dairy to red meat, with just about every meal. This kind of indifference is a problem. “The Japanese have one of the lowest rates of cardiovascular disease in the world, and that may be because they eat much less red meat and saturated fats than we do in America,” Welty says.
It should be noted that saturated fat is a controversial topic in nutrition research. Some experts have argued that saturated fats are to blame for health problems likely caused by processed meats, refined carbohydrates (such as those found in sugary or packaged foods), and trans fats in fast foods and some packaged snacks. Others have argued that if people avoid meat and dairy but end up eating more processed or refined carbohydrates, that’s an unhealthy trade. On the other hand, experts generally agree that trading saturated fats with some of the healthy foods listed above — such as fruits, vegetables, and nuts — is a very effective way to improve cholesterol scores and heart health. “If you reduce saturated fat in your diet, this is one of the best ways to lower LDL,” Welty says.
She adds that protein-rich soy products — from tofu to soy milk and yogurt — may also be good alternatives to meat, butter, milk and traditional sources of saturated fat. “People in America focus on protein, but Americans don’t really like eating soy products,” she says. This is unfortunate because research spanning several decades has linked soy to improved heart health and lower cholesterol levels. “If you need to replace saturated fats with other proteins, soybeans would be a good choice,” she says.
Swapping hoofed foods for feathered or finned foods is another good idea. “We often recommend substituting red meat and pork for fish and chicken,” Welty says. In particular, fatty fish like salmon, mackerel, and herring are heart-healthy options.
On the other hand, experts say that fish oil – a popular health supplement – is not a useful addition to your diet. “Fish oil does not lower bad cholesterol,” says Dr. Leslie Chu, MD, director of the Women’s Cardiovascular Center at the Cleveland Clinic. She says some prescription fish oil supplements can help lower triglycerides, so doctors sometimes recommend them. But commercial fish oil supplements have been linked to an increased risk of abnormal heart rhythms and should be avoided.
Last but not least, Cho says getting plenty of fiber in your diet—something most Americans fail to do—is very important. “Fiber can bind to dietary cholesterol and remove it from the body,” she says. “We want you to aim for 25 grams of soluble fiber per day.” This is possible if you eat a lot of vegetables, fruits and healthy whole grains such as oatmeal or flaxseeds. But supplements can also help you get there. Chu says ground psyllium seeds — sold under the brand name Metamucil, and also in less expensive (but identical) generic products — are a useful source of soluble fiber that can lower your LDL levels.
Non-diet approach to Cholesterol improvement
While lowering your LDL scores should be your primary focus, improving your levels of high-density lipoprotein (HDL) cholesterol — also known as the “good” type of cholesterol — is also important. “High-density lipoprotein absorbs cholesterol from the blood vessels like a vacuum,” Cho explains.
Exercise is one way to raise your HDL levels. “It can raise good cholesterol and also lower triglycerides,” Sperling says, another type of blood fat linked to cardiovascular problems.
However, when it comes to the best type of exercise for cholesterol, the search is all over the place. One review of studies published in 2020 in the journal systematic review, found that yoga has the strongest evidence in favor of its cholesterol-improving benefits. While many other types of exercise are undoubtedly beneficial for your heart and vascular system — and some, such as swimming and cycling, have been found to reduce cholesterol, more research is needed to determine what works best for altering cholesterol scores.
Some of Sperling’s research has also examined the benefits intermittent fasting on cholesterol levels. Intermittent fasting plans come in many different forms, but one type (known as time-restricted eating) has produced many promising research results. Time-restricted feeding involves daily fasting, usually anywhere from 12 to 16 hours, while the rest of the day is open to regular eating. For example, you can eat lunch, dinner, and snacks between noon and 8 p.m., but for the rest of the day, avoid all foods and drinks that contain calories. Time-restricted eating has been linked to significant weight loss — which often improves cholesterol scores — as well as lowering LDL and total cholesterol.
There are other ways to improve cholesterol naturally. But focusing on what and how you eat, as well as your exercise habits, is what experts say is so important.
Don’t wait to get started
While the health problems associated with high cholesterol and clogged arteries often don’t appear until people’s 50s or 60s, the buildup of primary plaques often begins decades before — in some cases, during a person’s 20s.
Researchers have found that taking steps to lower cholesterol early in life, before plaque buildup gains momentum, may lead to a threefold reduction in cardiovascular disease compared to delaying these health changes until middle age. The authors of a 2012 study wrote in Journal of the American College of Cardiology.
Sperling agrees, and says you can think of cholesterol health as an investment portfolio: The earlier you start, the higher the bottom line. “You want to start in your twenties, not your forties,” he says.
Even if it’s too late to start early, the most important thing is to get started. Cho says changing the diet and lifestyle to lower cholesterol, for example, can help those with heart disease who are already taking cholesterol-lowering medications to avoid strong medications and the side effects they may cause, such as joint pain and muscle cramps. “If you can make changes that prevent you from having to increase your dose, that’s fine,” she says.
Cholesterol problems are one of the most common age-related risk factors for heart disease. While medications can help, improving your eating and exercise habits can protect your heart and blood vessel system from potentially life-threatening risks.
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