Your cholesterol levels are important indicators of heart and blood vessel health. High cholesterol levels can contribute to the formation of plaque, which are deposits on artery walls that can narrow arteries and limit blood flow to vital organs, such as the heart. The result: cardiovascular disease — which can lead to a heart attack or the heart pain known as angina — and cerebrovascular disease, which can lead to stroke.
Lowering high cholesterol can help ease plaque build-up and lower your risk of cardio- and cerebrovascular disease. But there is controversy over the best way to do that. Because diet, particularly a diet high in saturated and trans fat, can contribute to high cholesterol, some people wonder if a low-fat diet alone — that is, without the help of cholesterol-lowering drugs like statins — could lower their cholesterol numbers.
Strict Diet Alone or Statin Therapy Too?
There is no one answer that works for everyone: It depends on the individual, where their cholesterol numbers are, and other factors such as age and additional heart disease risk factors, like diabetes, smoking, and family history of cholesterol issues or vascular disease.
“It depends on overall risk,” says board-certified cardiologist Robert M. Jarrett, MD, associate clinical professor of internal medicine at Yale University School of Medicine in New Haven, Conn. “We do risk stratification. For instance, a 20 year old with high cholesterol is at lower risk than a 55-year-old male with high blood pressure, who smokes, and has high cholesterol — and a much higher risk.”
Primary and Secondary Prevention for High Cholesterol
In general, when treating high cholesterol, one of two vascular disease prevention strategies is used: primary and secondary prevention.
Primary prevention is for the healthy person with high cholesterol but no history of vascular problems. “In primary prevention we often give the patient a chance to improve their numbers with diet,” says Dr. Jarrett. In some cases, primary prevention includes statin therapy. This may be the recommendation for people with very high cholesterol who would be unlikely to achieve necessary reductions through diet alone. “If your cholesterol is at 350, it’s unlikely that dietary changes will make enough of a difference. Being able to go from 210 to 160 is more achievable,” Jarrett explains.
For those trying diet alone, Jarrett says he gives his patients about four months between scheduled office visits to achieve some improvement. If the patient hasn't been able to stick to a diet and make notable changes in the numbers by that point, he will then usually start the patient on statin therapy.
Secondary prevention is for the patient who has already had a vascular event — a heart attack or stroke for instance. “Those are people in whom we’re trying to prevent further problems,” says Jarrett, who recommends that “all secondary prevention patients should be on a statin — no matter what their numbers are; the numbers aren’t good enough.”
But this doesn’t mean that taking statins gives you license to eat anything you want. “If I put someone on a statin, it’s not in lieu of an appropriate diet,” says Jarrett. “It’s in addition — you won’t get a response from a statin if you don’t fix the diet.”
Jarrett also stresses the importance of staying on medication. “The cholesterol medications work only as long as you take them. Cholesterol will start going back up within 24 to 48 hours — that’s why they have to be taken every day.”
A Strict Diet for Prevention: Pros and Cons
Reducing cholesterol through diet alone means better heart health without worrying about possible side effects of statins, which can include muscle and joint aches, nausea, diarrhea, constipation, and elevated liver enzymes.
The drawback is finding a diet that patients will stick with. While vegetarian or vegan diets are often successful in reducing cholesterol levels, they’re not diets that many people can live with, Jarrett says. “The diet that people can live on long-term is the Mediterranean diet — a small amount of meat and fish, lots of vegetables and fruit, whole grains, and olive oil and other monounsaturated oils.”
And there are no guarantees that diet will work well enough. How much you can expect to lower your cholesterol will vary. “Strong genetic factors can make it harder to lower cholesterol by diet alone — you would need to make significant changes in diet,” says Jarrett. Some people may be able to lower their cholesterol numbers by only 5 to 10 percent, while others can reduce it by 20 percent.
Ideas for Making a Strict Diet Work Better
Jarrett acknowledges that doctors don’t always have the chance to address the details of creating a cholesterol-lowering, low-fat diet plan and patients don’t always know how to do the research. If you need help revamping your diet, consider consulting with a registered dietitian. It will likely be worth the expense, even if your insurance doesn’t cover it,.
Nutritionist Susan Kraus, MS, RD, of Hackensack University Medical Center in New Jersey says, “By following specific guidelines with ongoing monitoring and support, it is possible to lower lipid levels through diet and lifestyle in certain individuals.”
Kraus cites a recent study published in the Journal of the American Dietetic Association that analyzed data from patients with high cholesterol who were counseled by registered dietitians. In one group of 175 patients on a program that included three or more consultations over an average of eight months, 44.6 percent of participants either reduced their levels of LDL cholesterol by at least 15 percent or reached their cholesterol goal.
Kraus’ advice? Focus on low-cholesterol, low-saturated fat foods, and high fiber, — particularly soluble fiber sources that bind with cholesterol and help the body eliminate it. Beans, fruits, oats, barley, and psyllium are some of the foods that contain this type of fiber.
Additionally, include more colorful fruits, vegetables, grains, nuts, legumes, and oily fish in your diet. These foods contain natural antioxidants and phytochemicals, and are thought to have an anti-inflammatory effect that may decreases both cardiovascular disease and other chronic disease risks.
Regardless of whether you are on statin therapy or aiming to beat high cholesterol with strict diet alone, this is a diet you can live with.
Last Updated: 1/11/2010