High blood cholesterol is a leading risk factor for cardiovascular disease. A report from the American Heart Association estimates that 16% of American adults have high total cholesterol.
The Interheart Study of heart disease in 52 countries reports that people with abnormal cholesterol levels have three times the risk of heart attack compared to those with normal cholesterol levels.
What is Cholesterol?
Cholesterol is a type of fat produced by the liver. It is a vital component of cell membranes and is needed for the synthesis of vitamin D. It is required for the production of hormones in the adrenal glands and the production of sex hormones. Cholesterol also plays a role in brain and immune system function.
Cholesterol is carried in the blood wrapped in substances called lipoproteins. Low-density lipoprotein (LDL), carries cholesterol toward the tissues. High-density lipoprotein (HDL), gathers it from the tissues and transport it to the liver.
LDL is known as the ‘bad’ cholesterol because it is found within the arterial plaques that causes atherosclerosis. Heart attack or stroke may occur if a blood clot blocks an artery narrowed by plaque deposits.
HDL is known as the ‘good’ cholesterol because it scavenges cholesterol from the tissues and may help to prevent it from building up in the linings of the coronary arteries.
A standard blood cholesterol test will show levels of total cholesterol, LDL cholesterol, HDL cholesterol and a form of fat called triglycerides. High levels of triglycerides indicate low levels of HDL. LDL cholesterol is usually not measured directly, but is calculated based on total cholesterol, HDL and triglycerides.
Most health care professionals in the U.S. use the following guidelines:
- 200 mg/dL or less is normal
- 201 to 240 mg/dL is borderline
- 240 mg/dL or more is high
- 60 mg/dL or higher is protective
- 40 to 59 mg/dL is normal
- Less than 40 mg/dL is low
- Less than 100 mg/dL is ideal for people at risk of heart disease
- 100 to 129 mg/dL is good
- 130 to 159 mg/dL is borderline (high)
- 160 to 189 mg/dL is high
High levels of cholesterol, especially in people with other risk factors for heart disease, are often treated with statin drugs which reduce the production of LDL cholesterol by the liver.
Stains can have side effects including muscle pain, digestive problems, liver inflammation, high blood sugar and cognitive impairment.
Statins also are not beneficial for everyone with high cholesterol. A meta-analysis of clinical trials publish in JAMA concluded that for women without cardiovascular disease, cholesterol-lowering drugs do not affect mortality rates from coronary heart disease. Even in women with known cardiovascular disease, statins do not affect overall mortality rates.
Fortunately, several foods have been shown to lower cholesterol in randomized controlled trials. Incorporating more of these into your diet could help to lower your cholesterol naturally.
7 Super Foods that Lower Cholesterol
Lycopene is a carotenoid responsible for the distinctive red colour in tomatoes and watermelon. It is also found in pink grapefruit, papaya, guava and rosehip.
Laboratory research has shown that lycopene inhibits cholesterol synthesis through a mechanism similar to that of the statin drug Fluvastatin. It also has antioxidant effects and can help to prevent the oxidation of LDL cholesterol which is associated with atherosclerosis.
A study published in the British Journal of Nutrition examined the relationship between lycopene intake and incidence of cardiovascular disease (CVD). Researchers analyzed data from 10 years of food frequency questionnaires completed by 5,135 participants in the Framingham Heart Study offspring cohort.
Consumption of tomato products was measured as servings per week of tomatoes, tomato sauce, tomato juice and pizza. Lycopene intake was calculated from food sources and multivitamins. Incidents of CVD were obtained from hospital records.
There were 314 cases of CVD over the study period. Both consumption of tomato products and total lycopene intake were found to be inversely related to coronary heart disease, such that the more lycopene consumed, the lower the risk.
A dietary intervention study investigated the effects of tomato products on cholesterol and LDL oxidation. Researchers recruited 21 healthy participants and asked them to abstain from consuming tomato products for 3 weeks. Next the participants went on a 3-week diet including 400 ml of tomato juice and 30 mg of tomato ketchup daily.
Both total cholesterol and LDL cholesterol were significantly reduced on the tomato diet compared to the tomato-free diet. The changes in cholesterol concentrations correlated significantly with the changes in blood levels of lycopene. The tomato diet also significantly increased LDL resistance to oxidation.
A pilot study published in Obstetrics and Gynecology Research examined the potential of a lycopene supplement as an alternative to hormone replacement therapy (HRT) for the prevention of coronary artery disease in postmenopausal women. A total of 41 healthy postmenopausal women were randomized to receive either combined HRT or supplements containing 2,000 µg of lycopene.
After 6 months HRT reduced total cholesterol by 24% and LDL cholesterol by 20%. It increased HDL cholesterol by 39%. Lycopene supplements reduced total cholesterol by 24% and LDL cholesterol by 15%. They increased HDL cholesterol by 26%. The researchers concluded that lycopene supplements can be used as an alternative to HRT to reduce the risk of atherosclerosis in postmenopausal women.
A meta-analysis examined the protective effect of lycopene on LDL cholesterol levels. When researchers analyzed the combined results of 8 trials with lycopene doses ranging from 4-44 mg daily, there was only a borderline significant reduction of LDL cholesterol in the lycopene group compared with the control group.
However, when the analysis focused on 4 trials using a lycopene dose at or above 25 mg a day, they found that it reduced LDL cholesterol by an average of 10%. The researchers note that this decrease is comparable to the effect of low doses of statin drugs and is clinically significant.
Method: The best dietary source of lycopene is red ripe tomatoes. Cooking and processing them further increases the lycopene content and bioavailability. Fresh tomatoes contain 3-5 ml of lycopene per 100 grams, whereas concentrated tomato paste contains 49-94 mg per 100 grams.
Lycopene capsules and tablets are available from health product suppliers. Take a daily dose containing 25-40 mg of lycopene to benefit from its cholesterol-lowering properties.
Walnuts are a rich source of alpha-linolenic acid, a type of omega-3.
Research has shown that alpha-linolenic acid from walnuts stimulates LDL receptor activity in the cells and promotes the removal of LDL cholesterol from the bloodstream, thereby decreasing LDL cholesterol concentrations.
In light of increasing evidence, the U.S. Food and Drug Administration approved a labelling health claim that daily consumption of 1.5 ounces of walnuts reduces the risk of heart disease.
A crossover trial published in the Annals of Internal Medicine assessed the effect of a walnut-enriched diet in men and women who had high cholesterol levels. Researchers randomly assigned half of the patients to eat a cholesterol-lowering Mediterranean diet with an emphasis on vegetables, fish and olive oil. Nuts were not allowed. The other half ate a similar Mediterranean diet with walnuts making up 35% of the fat content.
The patients followed their assigned diet for 6-weeks, then switched to the other type of diet for a further 6-weeks. Cholesterol levels were measured at the start and end of each diet. The Mediterranean diet alone decreased cholesterol levels by approximately 5%. Adding walnuts to the diet reduced total and LDL cholesterol by an additional 5%.
A clinical trial published in Metabolism assessed the effect of a walnut-enriched diet on cholesterol levels in 40 men and women aged 50 and over. Subjects were randomized to one of two diets: a Western-type diet consisting of 35% fat, 15% protein and 50% carbohydrates or a walnut-enriched diet which replaced 30 grams of saturated fat with 43 grams of walnuts. Subjects followed each diet for 8-weeks with a 2-week washout period in between.
Compared with the control diet, the walnut diet significantly reduced non-HDL cholesterol and apolipoprotein-B, the primary protein component of LDL particles. Both non-HDL cholesterol and apolipoprotein-B are strongly associated with an increased risk of coronary heart disease.
A systematic review published in the American Journal of Clinical Nutrition examined the effects of walnut consumption on cholesterol and other cardiovascular risk factors. Researchers analyzed data from 13 dietary intervention studies lasting 4-24 weeks with 365 participants. When compared with control diets, high-walnut-enriched diets resulted in a significantly greater decrease in total cholesterol and in LDL-cholesterol.
A study published in the Journal of Nutrition aimed to discover which components of walnuts were responsible for lowering cardiovascular disease risk. Researchers recruited 15 overweight adults with moderately high cholesterol and asked them to consume whole walnuts, walnut skins, defatted walnut meat and walnut oil.
The walnut components were consumed in random order in 4 weekly sessions. Blood samples were taken at various intervals following the walnut meal and an endothelial function test was conducted measure blood flow through the arteries.
Analysis of the results showed that walnuts protect against cardiovascular disease in two ways. Consumption of the whole nut significantly lowers cholesterol and consumption of walnut oil significantly improves blood vessel function.
Method: Substitute walnuts for unhealthy snacks like potato or corn chips and substitute omega-3 walnut oil for omega-6 vegetable oils.
3. Cocoa & Dark Chocolate
The cacao bean is rich in oleic acid, the same monounsaturated fat found in heart-healthy olive oil. It also contains flavonoids, polyphenols which act as powerful antioxidants and helps to protect LDL from dangerous oxidation.
Research has shown that polyphenols can also inhibit cholesterol absorption and biosynthesis. In addition to lowering cholesterol, cocoa or dark chocolate can help to protect against cardiovascular disease by lowering blood pressure and reducing inflammation.
An Australian study published in the BMJ concluded that providing people at high risk of cardiovascular disease with a daily bar of dark chocolate would be an effective and cost-effective disease-prevention strategy.
A population study published in the Archives of Internal Medicine evaluated whether cocoa intake was inversely related to cardiovascular mortality in elderly men. A cohort of 470 Dutch men aged 65-84 were followed up for 15 years. Every 5 years they were interviewed by a dietitian about their food intake over the previous month. The intake of cocoa from 24 individual foods was used to yield actual cocoa in grams per day for each subject.
Over the course of the study, 314 men died, and 152 of those deaths were due to cardiovascular diseases. Compared to those who consumed the least cocoa, those who consumed the most had a 45-50% lower risk of cardiovascular and all-cause death.
The researchers theorized that cocoa-containing foods could reduce cardiovascular risk due to their beneficial effect on blood pressure, cholesterol levels and prevention of LDL oxidation.
A trial published in the American Journal of Clinical Nutrition examined whether long-term intake of cocoa powder alters cholesterol profiles. Researchers recruited 25 healthy male participants and divided them into two groups matched for BMI and cholesterol levels. One group consumed 12 grams of sugar dissolved in hot water daily. The other consumed hot chocolate made up of 12 grams of sugar and 26 grams of cocoa powder.
Blood samples were taken at the start of the study and after 12-weeks. In the cocoa group, there was a 23% increase in HDL cholesterol and a 13% decrease in LDL cholesterol. In the control group, HDL increased by 5% and LDL decreased by 5%. Consumption of cocoa powder also significantly increased the resistance of LDL to oxidation.
A study published in the Journal of Nutrition evaluated LDL cholesterol and oxidized LDL concentrations following the consumption of different amounts of cocoa powder. Researchers divided 160 healthy men and women into 4 groups with similar cholesterol levels. One group got a placebo cocoa-flavored drink. The other 3 groups received beverages containing 13, 19.5 or 26 grams of cocoa powder daily for 4 weeks.
Blood tests showed favorable results for all 3 cocoa groups compared to the placebo group. Consumption of cocoa powder at a dosage of 13 grams per day or more decreased levels of LDL cholesterol, raised levels of HDL cholesterol and reduced oxidized LDL.
A meta-analysis published in the European Journal of Clinical Nutrition examined the effects of dark chocolate/cocoa product consumption on cholesterol. Researchers analyzed data from 10 randomized controlled trials from 6 countries with 320 participants. The studies compared dark chocolate or cocoa with a placebo or white chocolate and treatment ranged from 2-12 weeks.
The combined data showed that consumption of dark chocolate/cocoa products resulted in a statistically significant reduction in LDL and total cholesterol. The dark chocolate/cocoa effect was strongest in subjects with higher risk of cardiovascular disease.
Method: Choose a dark chocolate bar with at least 70% cocoa. Four squares or 1.4 ounces of 70% dark chocolate contain about 250 calories.
If you are watching your weight don’t simply add a daily dose of dark chocolate to your usual diet, substitute it for another treat with a similar number of calories.
- Dark Chocolate – 85% Cacao, Organic Bars
- Dark Cacao – Organic Chips
- Cacao Powder – Raw, Organic, Unsweetened (Dark Chocolate but Healthier)
- Very Dark Chocolate – Organic
- Cacao Powder – Raw, Organic, Unsweetened (Dark Chocolate but Healthier)
4. Oats/Beta Glucan
A type of soluble fiber called beta-glucan gives oatmeal porridge its pasty texture. When it reaches the gut, beta-glucan forms a thick gel which sticks to cholesterol and reduces its absorption. The gel and cholesterol are then excreted as part of the body’s waste.
Research has shown that beta-glucan also boosts the excretion of bile acids, which are needed for digestion. The body then uses cholesterol to make more bile acid, which results in a reduction in cholesterol circulating in the blood.
The US Food and Drug Association has approved a labelling claim associating beta glucan soluble fiber from oat bran, rolled oats or whole oat flour with reduced risk of heart disease.
A randomized controlled trial published in the Journal of the Academy of Nutrition and Dietetics evaluated a whole-grain, ready-to-eat oat cereal as part of a weight loss program. A total of 144 overweight and obese adults were put on a low calorie, low fat diet. Half the participants were instructed to eat two portions of oat cereal a day. The other half ate low fiber foods containing the same number of calories. Cholesterol levels, waist circumference and body weight were measured every 4-weeks. After 12-weeks, both groups lost approximately the same amount of weight. However, the oat cereal group had significantly greater reductions in LDL cholesterol, total cholesterol and non-HDL cholesterol levels.
A study published in The American Journal of Clinical Nutrition compared the effects of oat bran and wheat bran on cholesterol levels. A total of 20 men admitted to a metabolic ward with high cholesterol were put on a diet that was identical in calories and nutrients but differed in the amount of soluble fiber. Half the men received oat bran and half received wheat bran. After 21 days, oat bran significantly decreased total cholesterol by 13%, LDL cholesterol by 12 %, triglycerides by 10% and apolipoprotein B by 14%. Wheat bran had no significant effect.
A meta-analysis published in the American Journal of Clinical Nutrition examined the effect of oat beta-glucan on cholesterol concentrations in humans. Researchers compiled data from 28 randomized controlled trials comparing food products containing oats to similar products without soluble fiber. The trials included used doses of oat beta-glucan ranging from 3-12 grams per day and durations of treatment between 2–12 weeks.
The analysis concluded that any dose of oat beta-glucan over 3 grams per day significantly reduced LDL and total cholesterol. There was no evidence that higher doses of oat beta-glucan reduced cholesterol more than lower doses. There was a significantly greater cholesterol lowering effect in subjects with diabetes compared with those without.
Method: To get 3 grams of beta-glucan, aim to eat 2-4 portions of oat-based foods every day.
Start the day with a bowl of hot oatmeal or cold oat-based breakfast cereal. Use oat bread for toast or sandwiches. Top yogurt with toasted oats or granola.
- Beta Glucan – Veg Capsules
- Organic Old Fashioned Oatmeal, Breakfast Cereal
- Organic Oats, Old Fashioned
5. Green Tea
Green tea contains polyphenols known as catechins, including a powerful antioxidant called epigallocatechin gallate (EGCG).
Research has shown that that green tea catechins, particularly EGCG, interfere with the intestinal absorption of dietary fat and cholesterol and increase LDL receptor activity in the liver. Catechins also possess antioxidant and anti-inflammatory properties activities which effectively inhibit LDL oxidation and help to prevent atherosclerosis.
A population-based study published in Annals of Epidemiology investigated the association between green tea consumption and deaths from cardiovascular disease. A cohort of 14,000 Japanese men and women aged 65-84 completed questionnaires that included items about frequency of green tea consumption.
During 6 years of follow-up there were 1,224 deaths. Those who drank the most green tea were 76% less likely to die of cardiovascular disease than those who drank the least. Green tea consumption was also associated with reduced mortality from all causes.
Another Japanese study investigated the preventive effects of green tea against cardiovascular disease in 1,371 men aged over 40. The participants all gave blood samples during an annual health screening. They also completed surveys about lifestyle factors including green tea consumption. Increased consumption of green tea was associated with decreased blood concentrations of total cholesterol and triglyceride and an increased proportion of HDL cholesterol together with a decreased proportion of LDL cholesterol.
A clinical trial published in the Archives of Internal Medicine examined the effect of a green tea extract supplement on cholesterol levels. A total of 240 patients with mild-to-moderately elevated cholesterol were randomized to receive either capsules containing 150 mg of green tea catechins or placebo capsules. They were instructed to take one capsule daily for 12-weeks. The catenin extract capsules lowered total cholesterol by 11%, LDL cholesterol by 16% and triglycerides by 4%. HDL was raised by 2%. There were no significant changes in cholesterol in the placebo group.
A meta-analysis published in the American Journal of Clinical Nutrition examined the effect of green tea on cholesterol levels. Researchers collected data from 14 randomized controlled trials with 1,136 subjects. Trials used either green tea beverages or green tea extract and ranged in duration from 3 weeks to 3 months.
The analysis showed that both green tea beverages and green tea extract supplementation significantly reduce total cholesterol and LDL-cholesterol concentrations. The cholesterol changes were not influenced by treatment doses of green tea catechins, health status of participants or study duration.
Method: If you drink black tea or coffee on a regular basis, try switching to green tea. Alternatively, take a daily green tea supplement containing at least 175 mg of EGCG.
- Green Tea – Tea Bags, Organic
- Japanese Green Tea – Tea Bags, Organic
- Matcha Green Tea Powder – Organic
- Matcha Green Tea – Organic, Powder
Avocados are a good source of oleic acid, the same monounsaturated fat found in heart-healthy olive oil.
Research has shown that oleic acid can inhibit cholesterol synthesis. One Hass avocado contains approximately 13 grams of oleic acid, which is approximately the amount in 2 tablespoons of olive oil. Other nutrients in avocados may boost their cholesterol-lowering effects.
A crossover trial published in the Journal of the American Heart Association investigated the effect of avocados on cholesterol levels in 45 overweight and obese adults. The participants were assigned to a sequence of 3 different 5-week diets presented in random order: a low-fat diet, a moderate‐fat diet with oleic acid oils, or a moderate‐fat diet which included one fresh Hass avocado per day.
All 3 diets significantly decreased LDL and total cholesterol. However, the reduction was significantly greater in the avocado diet than either the low-fat or moderate-fat group. Avocado consumption reduced LDL cholesterol by 10%, total cholesterol by 8% and non‐HDL cholesterol by 9%.
Since the avocado diet was better at lowering cholesterol than the moderate-fat diet which included the same amount of oleic acid, the researchers concluded that the health benefits of avocados must be partly due to other nutrients or bioactives beside fatty acids.
A trial published in the American Journal of Clinical Nutrition compared the effects of an avocado-enriched diet and a high-complex-carbohydrate diet on cholesterol concentrations. Researchers assigned 15 women to two 3-week diets in random order. The AHA-III diet was similar to that recommended by the American Heart Association. The avocado-enriched diet was high in monounsaturated fatty acids.
Both diets lowered total cholesterol, but the avocado diet was more effective, with an 8% decrease compared to a 5% decrease for the AHA-III diet. LDL cholesterol and apolipoprotein B decreased significantly on the avocado diet, but not on AHA-III. HDL cholesterol did not change on the avocado diet, but decreased by 14% on the AHA-III diet.
A meta-analysis published in the Journal of Clinical Lipidology examined the impact of avocado-enriched diets on cholesterol levels. Researchers extracted data from 10 randomized clinical trials with 229 participants in which avocados were added to the diet or substituted for other sources of fat. The analysis showed that avocado consumption significantly reduced total cholesterol by 18.80 mg/dL, LDL cholesterol by 16.50 mg/dL and triglycerides by 27.20 mg/dL.
Method: Avocados are great when eaten whole or in sandwiches, salads or smoothies.
The hollow pit made when you remove the stone makes them ideal for stuffing with seafood or mixed vegetables. You can even use avocado in baking.
- Fresh California Hass Avocados
- Organic California Extra Virgin Avocado Oil
- Avocado Oil – All-Natural
Garlic contains a variety of organosulfur compounds such as allicin that have beneficial effects in the body.
Animal studies have shown that compounds in garlic inhibit enzymes that help to produce cholesterol in the liver, lowering concentrations of cholesterol in the blood.
A clinical trial published in the American Journal of Medicine assessed the effects of garlic powder tablets on cholesterol levels. A total of 42 men and women with total cholesterol over 220 mg/dL were randomized to receive 900 mg of garlic supplements daily or a placebo. After 12-weeks, supplementation with garlic reduced LDL cholesterol by 11%. It also produced a significantly greater reduction in total cholesterol compared to the placebo.
A study published in the American Journal of Clinical Nutrition examined the effects of garlic and fish-oil supplementation on cholesterol levels. Researchers assigned 50 men with moderately high cholesterol to one of four groups: 2 placebo capsules; placebo + 12 grams fish oil; 900 mg garlic + placebo; 900 mg garlic + 12 grams fish oil. The men took the capsules daily for 12-weeks.
There was no change in cholesterol in the placebo group. Total cholesterol was reduced by 12% in the garlic group and the garlic and fish oil group but was not significantly reduced in the group that had fish oil alone. LDL-cholesterol was reduced by 14% in the garlic group and 10% in the garlic and fish oil group. The garlic groups also had significantly lower ratios of total cholesterol to HDL cholesterol.
A meta-analysis published in the Annals of Internal Medicine assessed garlic’s effect on total cholesterol in people with cholesterol levels greater than 200 mg/dL. The pooled data showed that patients treated with garlic had a consistently greater reduction in total cholesterol levels compared with those given a placebo. The researchers concluded that one half to one clove of garlic daily decreased total cholesterol by about 9%.
Method: To get the most benefit from garlic, finely chop or crush it to release the sulfur compounds and combine it with cooked food shortly before serving.
Alternatively, take a 900 mg of a garlic supplement daily.
To lower your cholesterol naturally, cut out junk food, fast food and processed foods and cook simple dishes with fresh ingredients.
Replace unhealthy choices with cholesterol-lowering foods. Don’t rely on one single food from those listed above. If you consume oatmeal for breakfast, avocado salad for lunch and baked chicken in tomato and garlic sauce for dinner, you’ll benefit from the combined effects of their different cholesterol-lowering properties.