Preventive Medicine and
Almost every adult living in an
industrialized nation develops some degree of atherosclerosis,
commonly known as “hardening of the arteries.” In the U.S., many
children have fatty streaks, or “pre-atherosclerosis,” in their
arteries. Atherosclerosis leads to strokes, heart attacks, and
other serious health problems.
Heart disease is linked to risk factors. The
principal risk factors are high cholesterol levels, smoking, and
high blood pressure. Other risk factors include: diabetes,
obesity, family history of heart disease, and stress. Following is
an overview of how food choices can affect one’s cholesterol
Every animal cell, both human and nonhuman,
contains cholesterol. Cholesterol is important in some cell
functions, and the liver produces all of the cholesterol the body
needs. There is no need to consume any in one’s diet.
Cholesterol and fats move through the body
in protein packages called lipoproteins. Low density lipoproteins
(LDLs) carry cholesterol to the organs through the arteries. The
LDLs deposit their loads through the inner walls of the arteries.
This process encourages the growth of deposits, called plaques, on
the artery walls which narrow the artery and obstruct the flow of
blood. This is atherosclerosis. If the blood flow to the heart is
blocked, a heart attack can occur. If the blood flow to the brain
is blocked, a stroke can occur. Since LDLs promote
atherosclerosis, they are known as “bad cholesterol.” The higher
the LDL level, the higher the risk of heart problems.
“Good cholesterol,” found in high density
lipoproteins (HDLs), moves back to the liver where it is disposed
of. People who exercise, don’t smoke, and stay at their ideal
weight tend to have higher levels of HDLs. Since the majority of
cholesterol is in the form of LDLs, a high blood cholesterol level
means high LDL levels. Blood cholesterol levels are affected by
many factors. But even people with a hereditary tendency toward
heart disease can do something about their cholesterol levels.
This is very important because with every 1 percent reduction in
total blood cholesterol, there is about a 2 percent reduction in
the risk of heart attack.1 Population groups with an
average cholesterol level of 150 or less are largely free of
atherosclerosis. For cholesterol levels above 150, the risk of
heart disease increases.2 Following are some guidelines
for lowering blood cholesterol:
Fat Intake, Especially Saturated Fats
Saturated fats raise cholesterol levels, but
are easy to avoid. Saturated fats are solid at room temperature.
They are found predominately in animal products but are also found
in a few vegetable oils, such as palm oil, coconut oil, chocolate,
and hydrogenated oils.
Cholesterol in foods increases levels of
LDLs.3 Cholesterol is found only in animal products.
Meat, fish, poultry, dairy products, and eggs all contain
cholesterol, while plant products do not. Choosing lean cuts of
meat is not enough; the cholesterol is mainly in the lean portion.
Many people are surprised to learn that chicken contains as much
cholesterol as beef. Every four-ounce serving of beef or chicken
contains 100 milligrams of cholesterol. Most shellfish are very
high in cholesterol. There is no “good cholesterol” in any food.
Cholesterol in foods raises the cholesterol level in one’s blood.
The best thing to do is to keep one’s fat intake very low and to
avoid all animal products.
As suggested above, basing one’s diet on
plant foods—grains, beans, vegetables, and fruits—is the best way
to keep saturated fat intake low and to avoid cholesterol
completely. A vegan diet is free of all animal products and yields
the lowest risk of heart disease. One study showed that people who
adopt a vegetarian diet reduce their saturated fat intake by 26
percent and achieve a significant drop in cholesterol levels in
just six weeks.4 Besides the very low levels of fat
eaten in a typical vegetarian diet, vegetable protein also helps
decrease risk for heart disease. Studies have shown that replacing
animal protein with soy protein reduces blood cholesterol levels
even when the total amount of fat and saturated fat in the diet
remain the same.5
The Added Advantage of a Vegetarian Diet
Soluble fiber helps to slow the absorption
of some food components such as cholesterol. It also acts to
reduce the amount of cholesterol the liver makes. Oats, barley,
beans,6 and some fruits and vegetables are all good
sources of soluble fiber. There is no fiber in any animal product.
Your Ideal Weight
Losing weight helps to increase HDL levels
(the “good cholesterol”). Carrying excess weight can affect one’s
risk for heart disease. People who are thick around the middle
(“apple-shaped”) are at a higher risk than those who carry excess
weight around the hips and buttocks (“pear-shaped”).7
“Apple-shaped” people should lose weight through a low-fat diet
and aerobic exercise.
Eat Lots of
People who eat frequently throughout the day
have lower cholesterol levels. In one study, men consumed either 3
meals a day or 17 snacks a day. The snackers experienced a
reduction in cholesterol levels in comparison to the
Mental stress causes an increased release of
adrenaline which may elevate blood cholesterol levels. Relaxation
techniques such as stretching, deep breathing, or meditation help
in lowering blood cholesterol.
Aerobic exercise raises levels of HDL-cholesterol
and may also reduce levels of LDLs. Exercise also has other
benefits for the heart: it strengthens the heart muscle, promotes
weight loss, and lowers blood pressure. Exercise can also help
reduce stress. Exercise does not have to be terribly vigorous A
daily half-hour walk is helpful.
Some people have been promoting fish oil
supplements as a means to reduce blood cholesterol. However,
studies show that they do not lower cholesterol levels. While they
may affect triglycerides (fats in the blood), they also may change
the overall pattern of lipoproteins in one’s blood in a way that
is not beneficial.9 A diet including fish is not as
beneficial as a pure vegetarian diet.
There have also been reports that alcohol
raises one’s levels of HDLs. But recent studies have shown that
alcohol does not raise the type of HDL that protects against heart
disease. Alcohol address extra calories to the diet and increases
the risk for some forms of cancer.
Tobacco poisons one’s heart as well as
In order to stop and to reverse
atherosclerosis, it is important to take all of these guidelines
to heart. Making only modest changes yields only modest results. A
low-fat, vegetarian diet coupled with exercise, smoking cessation,
and stress reduction program is the best way to lower one’s
cholesterol levels and can even reverse heart disease for many
people.10 Well-documented information can be found in
Foods That Fight Pain; Eat Right, Live Longer; and
Food for Life by Neal Barnard, M.D., and Dr. Dean
Ornish’s Program for Reversing Heart Disease by Dean Ornish,
1. National Institutes of Health Consensus Development
Conference Statement. Lowering Blood Cholesterol to Prevent Heart
2. Pooling Project Resource Group. Relationship of blood pressure,
serum cholesterol, smoking habit, relative weight and ECG
abnormalities to incidence of major coronary events: final report
of the Pooling Project. J Chronic Dis 1978;31:201-306.
3. Johnson C, Greenland P. Effects of exercise, dietary
cholesterol, and dietary fat on blood lipids. Arch Intern Med
4. Masarei JR, Rouse IL, Lynch WJ, Robertson K, Vandongen R,
Beilin LJ. Vegetarian diet, lipids and cardiovascular risk. Aust
NZ J Med 1984;14:400-4.
5. Carroll KK, Giovannetti PM, Huff MW, Moase O, Roberts DC, Wolfe
BM. Hypocholesterolemic effect of substituting soybean protein for
animal protein in the diet of healthy young women. Am J Clin Nutr
6. Swain JF, Rouse IL, Curley CB, Sacks FM. Comparison of the
effects of oat bran and low-fiber wheat on serum lipoprotein
levels and blood pressure. N Engl J Med 1990;322(3):147-52.
7. Krotkiewski M, Bjorntorp P, Sjostrom L, Smith U. Impact of
obesity on metabolism in men and women: importance of regional
adipose tissue distribution. J Clin Invest 1983;72:1150-62.
8. Jenkins DJ, Wolever TM, Vuksan V, et al. Nibbling versus
gorging: metabolic advantages of increased meal frequency. N Eng J
9. Grundy SM, Denke MA. Dietary influencees on serum lipids and
lipoproteins. J Lipid Res 1990;31:1149-72.
10. Ornish D, Brown SE, Scherwitz LW, et al. Can lifestyle changes
reverse coronary heart disease? Lancet 1990;336:129-33.