A vegetarian diet can help lower cholesterol even without statins

A vegetarian diet can help lower cholesterol even without statins

Julia Kim, 64, an IT professional from Boston, started taking a statin more than 30 years ago because of a family history of high cholesterol.

But six months ago, tired of taking the medication and its side effects, she stopped working, and within three days, the chronic back pain she’d had for decades was gone. An avid runner, she is thrilled to be pain-free, but is at a loss about how to control her cholesterol.

“I feel better than I did in 30 years, but my cholesterol numbers are going up,” Kim said. “I don’t want to control my cholesterol with medications. Every medication has side effects. I need to find a natural way to deal with this.”

Kim is not alone. Many people don’t want to take statins, and some people can’t take them. Statins are effective and considered safe for most people, but they increase the risk of side effects, including muscle pain, liver problems, mental confusion and possible diabetes.

“Nobody wants to start taking medication,” said Donald Hensrud, MD, assistant professor of nutrition and preventive medicine at the Mayo Clinic College of Medicine. “We’re all getting older, and things usually go up with age: cholesterol, weight, blood pressure. At some point, people face this.”

Cholesterol is a waxy, fatty substance found in the blood and produced by the liver and from the food we eat. There are two types: low-density lipoprotein, or LDL, the “bad” cholesterol, and high-density lipoprotein, or HDL, the “good” type. (Think of the “L” for “deadly” and the “H” for “healthy.”) Triglycerides — another type of fat — also contribute to cholesterol buildup. Cholesterol is measured in milligrams per deciliter of blood — or mg/dL. Ideally, healthy people should have an LDL level of 100 mg/dL or less and an HDL level above 60.

Cholesterol isn’t inherently bad — the body uses it to make cells, vitamins and certain hormones — but too much LDL can build up inside your arteries, increasing your risk of heart disease and stroke. On the other hand, a high HDL level helps protect the heart by carrying some LDL away from the arteries and back to the liver, where it is broken down and eliminated.

For those who avoid drugs, experts say the best way to control cholesterol is through a disciplined diet and healthy habits such as regular exercise and adequate sleep. One caveat: Be sure to check with your doctor before stopping the medication. They may also order periodic blood tests to monitor your cholesterol.

“When people are willing to commit to an ideal diet, there is no doubt that it is better than any medicine we have,” said David Katz, former president of the American College of Lifestyle Medicine and founding director of Yale-Griffin Prevention Research at Yale University. center.

There are other health benefits, such as weight loss and lowering “blood pressure and blood glucose, which reduces the risk of heart disease separate from cholesterol,” Hensrud said.

Experts recommend a vegetarian diet rich in soluble fiber – oatmeal, oat bran, beans, apples, peas, citrus fruits, carrots, barley, flax seeds, a gelatinous powder called psyllium, as well as nuts and plant sterols, which are found in small quantities in fruits and vegetables. Extra virgin olive oil and nuts, and it is also added to some spreads, milk and yogurt.

They also urge consumers to avoid saturated fats, which are commonly found in fatty and processed meats, butter, and tropical oils such as palm and coconut. Choose unsaturated or polyunsaturated oils, such as corn, canola, sunflower and sesame. Experts said that saturated fats raise blood cholesterol more than the cholesterol found naturally in eggs and oysters.

Surprisingly, some research suggests that moderately unprocessed cheese reduces the risk of cardiovascular disease. “The only exception to the rule of cutting down on saturated fat may be if it’s not consumed in excess,” Hensrud said.

What about eggs? Hensrud said that Americans’ relationship with whites is complicated: “One year it’s bad, and the next year it’s fine.” “Egg whites are pure protein, and the yolk contains dietary cholesterol and a small amount of saturated fat. They increase the risk, but not by a significant amount, which is why the American Heart Association suggests up to one egg per day.”

Vegetarian eating plan

Many experts recommend the Portfolio Diet, a plant-based eating plan designed by David Jenkins, a professor in the departments of nutritional sciences and medicine at the Temerty Faculty of Medicine at the University of Toronto. It strongly emphasizes eating soluble fiber and sterols and eliminating processed foods. An early study by Jenkins and colleagues compared the cholesterol-lowering effects of the Portfolio Diet with those of statins and found no significant differences.

“We need to focus more on helping people understand these plant-based diets,” Jenkins said. “Some people have never tasted lentil soup, for example. It can be delicious, nutritious and good for cholesterol levels. We are dedicated to empowering people to learn how to eat a plant-based diet. “I know it can be difficult, which is always a problem with any diet.”

People don’t have to switch suddenly, he said. “Start by introducing certain foods gradually,” he said. “The idea is to move towards making plant-based eating a way of life.”

Katz agreed, saying it’s easy to retrain taste buds: “Taste buds are adaptable little guys. When they can’t eat the foods they like, they like the foods they eat.”

Be careful when taking nutritional supplements, which are largely unregulated by the Food and Drug Administration. For example, Hensrud advised against using niacin, which lowers cholesterol but has side effects, including facial flushing. It can also raise liver enzymes when taken in large doses, Hensrud said. “No one should use it anymore,” he said.

When statins cannot be avoided

Some people cannot lower their low-density lipoprotein (LDL) level without medication because of genetic conditions that predispose them to high cholesterol, the most important of which is familial hypercholesterolemia, or FH, which is a genetic defect in the body’s ability to process low-density lipoprotein (LDL). LDL). “They will always have to take statins” with other medications, although those who stick to diet and lifestyle may benefit, Jenkins said.

For example, one of Jenkins’ patients with the disorder refused to take medication—against medical advice—and lowered her low-density lipoprotein (LDL) level through exercise and a portfolio diet, even though it was “not as high as we would like.” , said Jenkins. However, Jenkins said: “It’s amazing compared to what it was like when she first came to see us.” “She improved unexpectedly well due to careful attention to diet, which is very, very rare.”

Not everyone with a family history has FH. Kim is one of them. She plans to try diet and exercise. “I think I’ll be able to do it,” she said.

Experts noted that components of many healthy eating plans — the DASH diet, the Mediterranean diet, and the Mayo Clinic diet, for example — are valuable.

“They all include minimally processed foods and are mostly plant products,” said Hensrud, author of the Mayo Clinic Diet. “The combined effect will generally be lowering LDL. This gives people options. You can choose what suits you from each one of them.”

But the Portfolio Diet is “the ultimate dietary response to cholesterol,” Katz said.

“But keep in mind that the only effective diet is the one you want to eat,” he added.

Do you have a question about healthy eating? e-mail EatingLab@washpost.com We may answer your question in a future column.

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