Using Foods to Lower Cholesterol
For diabetic patients, following a proper diet is not only essential to lowering blood sugar but also for keeping cholesterol levels low. Unfortunately, diabetes and hyperlipidemia (high cholesterol) tend to go hand in hand. Diabetics can see the effects of food on their blood sugar every day. It should come as no surprise that choosing proper foods also can have a profound effect on controlling cholesterol levels. For years patients have been told to adhere to a diet that is low in saturated fats. However, research has been emerging over recent years suggesting that there are more powerful dietary foods to reduce cholesterol.
photo credit: s58yDiabetic patients have more aggressive goals for controlling their cholesterol than the general population does. When cholesterol levels become elevated, diabetic patients are often prescribed medications to help lower cholesterol. This can be frustrating for patients who are already taking multiple medications to control blood sugar levels. Interestingly, for only mildly elevated cholesterol levels it may be possible to reduce cholesterol naturally. In recent years, clinical trials have supported the use of dietary changes for lowering bad cholesterol (LDL).
What is the Portfolio Diet?
Using foods to lower cholesterol is not a new concept but for decades the emphasis has been placed on following a low fat diet to keep cholesterol in check. In recent years, studies have shown that a combination of low fat diet and the incorporation of cholesterol lowering foods can have a significant impact on cholesterol levels. This is great news for patients that are resistant to starting medications that have side effects and potential interactions with other drugs. In fact, a recent study published in JAMA has demonstrated that using the portfolio diet method can decreased LDL levels by more than 25 points! This reduction can make a significant difference for a diabetic patient who has an aggressive LDL goal of less than 100 mg/dl (and sometimes even lower!).
The portfolio diet menu includes foods that reduce cholesterol by adding the following four types of heart healthy foods:
- Soy Protein: Patients with high cholesterol are encouraged to substitute meats with soy based proteins, soy milk, tofu or soy beans. Patients should aim for two servings per day.
- Soluble Fiber: The portfolio diet advises the use of sticky fiber such as eggplant, okra, oats, psyllium and barley to help lower cholesterol naturally. Try to incorporate two servings of soluble fiber per day.
- Plant Sterols: The use of plant sterol esters, which can be found in specialty margarines, can be used instead of butter and can help decrease LDL substantially. Two teaspoons of plant sterol foods to reduce LDL every day.
- Nuts: It is no secret that nuts have heart healthy qualities. The portfolio diet advises the daily use of a handful of tree nuts, particularly almonds, for this high cholesterol diet.
Supported By Research: Using Foods to Lower Cholesterol
Adding these four types of foods to lower cholesterol has been most effective when combined with a low fat diet. When combined with regular dietary counseling, this diet strategy was even more effective.
A 2011 publication in the Journal of the American Medical Association revealed results of a six month study containing 351 patients that compared the use of the portfolio diet and a traditional low fat diet and demonstrated that the portfolio diet plan can significantly reduce LDL cholesterol levels. This research showed a 13.8% (or 26 mg/dl) reduction in LDL levels for patients using the portfolio diet as compared to a 3.0% (or 8 mg/dl) reduction in LDL levels for standard low fat diet (Jenkins, et. al.).
Another study, based in Canada, compared the use of portfolio foods to lower cholesterol with both a very low saturated fat diet and with 20 mg of lovastatin therapy. This study found similar reduction in LDL levels between the dietary portfolio group and the lovastatin group. Both groups showed a significant reduction in comparison to the dietary control group of a very low saturated fat diet (Gigleux, et. al.).
The good news for diabetic patients is that these types of foods that are included in the portfolio diet to reduce cholesterol naturally can be part of a healthy diabetic diet as well. Soy proteins and nuts provide a healthier alternative to red meats as a protein source but diabetic patients must not forget to keep portion sizes appropriate. In addition, fiber is an excellent way to stabilize blood sugar and now evidence supports the use of soluble fiber to lower LDL cholesterol! Explore Know Your Sugar for more information about natural ways to improve your health and how to control your diabetes!
Jenkins, et. al., (2011) Effect of a Dietary Portfolio of Cholesterol-Lowering Foods Given at 2 Levels of Intensity of Dietary Advice on Serum Lipids in Hyperlipidemia: A Randomized Controlled Trial JAMA. 2011;306(8):831-839. http://jama.ama-assn.org/content/306/8/831.short
Gigleux, et. al., (2007) Comparison of a dietary portfolio diet of cholesterol-lowering foods and a statin on LDL particle size phenotype in hypercholesterolaemic participants. Br J Nutr. 2007 Dec;98(6):1229-36. Epub 2007 Jul 30. http://www.ncbi.nlm.nih.gov/pubmed/17663803
For people with high cholesterol levels it is often a challenge to get their cholesterol to goal. Often doctors recommend medications to help get control of high lipids to prevent complications such as coronary artery disease, heart attack and stroke. These medications aren’t without side effects and can interact with other medications that people are prescribed. In addition, routine lab work is necessary to be sure that the medications are helping and to monitor liver function. For patients with only mildly elevated cholesterol it may be possible to reduce LDL significantly using simple dietary changes.
In recent years, clinical studies have examined the incorporation of a dietary portfolio into the management of hyperlipidemia. What researchers have found is that by adding foods known to reduce cholesterol levels, patients can have substantial improvement in their cholesterol. In addition, the dietary portfolio has been found to be more effective than a low fat diet alone! Also, some studies suggest that it may be as effective as a low dose of cholesterol lowering medication.
So what is the portfolio diet? Although not specifically marketed as a diet plan, the dietary portfolio adds the four following foods to your diet to help lower LDL levels by as much as 10%.
- Fiber: Sticky fiber from oats, barley and vegetables should be included in all patients’ diets to help lower lipids. Other benefits of fiber include the regulation of gastrointestinal health and stabilization of blood sugar levels. Most Americans do not obtain enough dietary fiber so an increase should benefit almost anyone.
- Soy Protein: Replacing more traditional protein sources with soy protein has been shown to improve cholesterol in multiple studies. Try adding soy beans, soy milk or tofu more routinely.
- Plant sterols: These compounds can help decrease cholesterol and are found in specialty margarines. Use these in place of regular butter and margarine.
- Nuts: Nuts are an excellent source of protein, heart healthy fats and now are shown to reduce LDL when used in combination with the above four foods. Add a handful of nuts per day to almost any diet to improve cardiovascular health.
Patients with all kinds of health problems can benefit from adding these foods to their diet. For example, patients with diabetes can also see the added benefits of improved a1c blood sugar test results by adding more fiber. Factor in these added benefits, plus the cholesterol fighting power of the above foods and it seems obvious that almost anyone can benefit from improving their dietary portfolio.