Category: Cholesterol

HDL cholesterol, known as “good” cholesterol, is important in lowering the risk of heart disease.

Eating almonds improves the levels of ‘good’ cholesterol as well as removing ‘bad’ cholesterol, a study reveals.

Good cholesterol, known as high-density lipoprotein (HDL cholesterol), is important in lowering the risk of heart disease.

Almonds are nutritious and high in vitamins E and B.

They are also a source of minerals such as calcium, copper, iron, magnesium, manganese, phosphorus, and zinc as well as providing good levels of fat and fibre.

Almonds can raise the functioning of HDL cholesterol, which gathers ‘bad’ cholesterol from tissues like the arteries and helps to transport it out of the body.

The randomised controlled trial showed that the levels and function of HDL cholesterol were improved in people who had a diet with 43g of unsalted, whole, natural almonds a day for 6 weeks

This group was compared to people who had a similar diet, but instead of almonds ate a muffin.

The researchers found that while participants were on the almond diet, their HDL levels and functionality improved.

Professor Penny Kris-Etherton, an author of the study, said:

“HDL is very small when it gets released into circulation.

It’s like a garbage bag that slowly gets bigger and more spherical as it gathers cholesterol from cells and tissues before depositing them in the liver to be broken down.”

HDL cholesterol is categorised into different subspecies and particle sizes which range from the very small pre-β-1 HDL to the very large α-1 HDL.

High concentrations of pre-β-1 HDL and low concentrations of α-1 HDL, alone or in combination, have been shown to increase the risk of cardiovascular disease.

Introducing almonds to a low-fat diet improves HDL subspecies and function and prevents decreases in α-1 HDL, which is caused by the traditional low-fat diet.

Professor Kris-Etherton said:

“We were able to show that there were more larger particles in response to consuming the almonds compared to not consuming almonds.

That would translate to the smaller particles doing what they’re supposed to be doing.

They’re going to tissues and pulling out cholesterol, getting bigger, and taking that cholesterol to the liver for removal from the body.”

The study was published in The Journal of Nutrition (Berryman et al., 2017).

Bempedoic acid is cholesterol-lowering option for statins users who experience some side effects.

Patients who can’t tolerate statins could try bempedoic acid, a cholesterol-lowering drug instead.

In February 2020, the safety and effectiveness of this oral medication was approved by the U.S. Food and Drug Administration (FDA).

Bempedoic acid

Bempedoic acid, like statins, blocks an enzyme called ATP-citrate lyase that our body uses for producing cholesterol.

This once daily pill can be taken along with patients’ diet and existing treatments or as an alternative to statins for patients who have a bad reaction to statins or interactions with other drugs.

It also reduces low-density lipoprotein (LDL) cholesterol in contrast to people taking statins who continue to have elevated levels of this bad cholesterol.

Professor Kausik Ray, the study’s first author, said:

“We know that reducing your cholesterol levels is key to cutting the risk of heart attack and stroke, particularly if you already have established heart disease.

Our latest study shows that bempedoic acid could be another addition to the arsenal of cholesterol-lowering treatments available to patients.

What we have is a new class of drug that could be given to patients who are already taking statins and could help them to further reduce their cholesterol levels and thus potentially cut their risk of heart attacks and strokes.”

According to The World Health Organization (WHO), 17.9 million lives are taken by cardiovascular diseases (CVDs) each year globally.

Heart disease is responsible for 840,768 deaths in the United States, accounting for one in every three deaths each year.

High cholesterol level is a risk factor for CVD as accumulation of LDL hardens the arteries and blocks the blood flow which can lead to heart attack and stroke.

Statins are prescribed to reduce cholesterol levels especially in patients at high risk of heart attack or stroke but like most drugs it has side effects.

Researchers believe that bempedoic acid, unlike statins, only works in the liver and it is not able to enter the muscles.

Professor Ray said:

“One of the key advantages of bempedoic acid is supposed to be that it shouldn’t cause the muscle side effects reported by some statins users, as it taken up by the liver and needs to be converted into its active form via an enzyme only found in the liver.

Once converted to the active form the drug cannot leave the liver, so it can’t enter muscles and hence could be of considerable advantage for some.

It could be an option for patients who are unable to tolerate statins at higher doses, or at all.

Our genetic studies suggest that the benefit on prevention of heart disease and strokes in ongoing trials should be identical to that achieved through statins.”

The study was published in the New England Journal of Medicine (Ray et al., 2019).

The benefits of statins versus the side-effects: is it worth taking the medication?

Statins are one of the most commonly prescribed medications with over 200 million people taking it.

Statins are designed to decrease the risk of heart disease and stroke by slowing down the production of low-density lipoprotein (LDL) cholesterol in the liver.

High LDL cholesterol or ”bad cholesterol” can cause hardening and narrowing of the blood vessels.

If the blood vessels become narrow, the body can’t get enough oxygen-rich blood and so this can lead to a stroke.

For patients with cardiovascular disease, the benefits of statins are greater than the side-effects.

But, preventing heart disease with statins is a different story as the health outcome of the drug compared to the harm might not be so positive.

Muscle pain, muscle weakness, sleep problem, fatigue, dizziness, headache, and indigestion are the common side-effects that make many people hesitant about taking statins.

In contrast, the guidelines recommend a wider use of statins making those with a lower risk of cardiovascular disease eligible for taking the medication.

Therefore, a research team aimed to investigate the links between statins and adverse events in people with no prior history of cardiovascular disease.

They also checked if the types and doses of statins would make any difference regarding side-effects.

The team looked at 62 trials involving 120,456 participants with 4 years follow-up.

The analysis showed that statins were linked to an increased risk of self-reported muscle pain, liver and kidney problems, and eye conditions.

However, the study didn’t find any association between statins and clinically confirmed muscle disorders or risk of diabetes.

They suggest that the potential benefits from statins are favourable when compared to the harm.

There was not enough evidence showing dosage or any specific type of statin would cause more or less adverse events.

Rosuvastatin, atorvastatin, and lovastatin all showed similar side-effects, and a higher dosage of atorvastatin was linked to liver dysfunction.

Because of the side-effects of statins, researchers are looking for alternatives to lower cholesterol.

One method is the use natural foods with cholesterol-lowering properties.

One study gave patients foods such as walnuts, dark chocolate and smoothies containing strawberries and bananas.

Moreover, side effects such as muscle pain from taking statins can be reduced with exercise.

The study was published in the BMJ (Cai et al., 2021).

Statins may reduce the risk of a heart attack by as much as one-third.

Statins are cholesterol-busting drugs that are designed to reduce the risk of heart disease and stroke.

However, some people naturally worry about the side-effects these drugs may have, despite the fact that they are one of the most commonly prescribed drugs.

Statins may reduce the risk of a heart attack by as much as one-third.

Still, many refuse to take them because around 20 percent of people report side-effects.

Some of the most common side-effects are fatigue, muscle aches and joint pain.

Other common side-effects of statins are headaches, stomach pain, dizziness, constipation and feeling sick.

In addition, some people taking the cholesterol medication report pins and needles in their hands and feet.

The ‘nocebo’ effect

However, research suggests that some of these people may be experiencing the ‘nocebo’ effect.

The nocebo effect is when a person experiences side-effects due to the negative associations the drug has rather than because of its pharmaceutical effect.

One study has found that 90 percent of symptoms reported were from patients who were taking a placebo.

In other words, many people, despite taking a pill with no medicine in it, are still getting side-effects.

Dr James Howard, study co-author, explained:

“Statins are life-saving treatments that can help prevent the risk of heart attacks, strokes and cardiovascular disease.

Previous studies have shown that statins are safe and effective at preventing serious health conditions but some patients stop taking or refuse the drug due to reported side effects, potentially increasing their risk of heart attack and stroke in the long-term.

Our study suggests that the reported side effects of statins are not caused by the statin themselves but by the effect of taking a tablet.

Some of the side effects could also be from the typical aches and pains of getting older.

Our findings are significant because they are further evidence that side effects from statins are minimal.

These drugs play a significant role in keeping patients who are at risk of cardiovascular disease healthy.

One way to help encourage patients to take or stay on their medication is for doctors to talk to their patients about the nocebo effect.

In more severe cases patients could be referred for talking therapies.”

The study was published in the New England Journal of Medicine (Wood et al., 2020).

This diet is the most effective regimen for reducing “bad” cholesterol, a review of 49 studies confirms.

A plant-based diet — particularly a vegan diet — can substantially lower total cholesterol, including low-density lipoprotein (LDL) or “bad” cholesterol in four weeks.

A review of 49 studies found that plant-based diets including vegan and vegetarian diets reduced total cholesterol levels up to 29.2 milligrams per deciliter (mg/dl).

The reduction of LDL cholesterol levels was up to 22.9 mg/dL and for HDL cholesterol up to 3.6 mg/dL when compared to other diets such as a low-fat omnivorous diet.

The strong effect of plant-based diets on lowering cholesterol levels is probably related to weight loss and body fat and because these types of foods are low in saturated fat and calories.

Also plant-based diets contain legumes, vegetables, whole grains, fruits, seeds, and nuts which are high in fibre and plant sterols.

Ms Susan Levin, study co-author, said:

“The immediate health benefits of a plant-based diet, like weight loss, lower blood pressure, and improved cholesterol, are well documented in controlled studies.

Our goal with studying plasma lipids throughout the lifespan is to capture the net risk reduction of using a vegetarian diet to control lipid levels.

We hope to empower patients with new research about the long-term cardiovascular health benefits of a vegetarian diet, which include a reduced risk of a heart attack, stroke, and premature death.”

Dr Charles Ross, a physician, managed to lower his cholesterol from 230 mg/dL to a healthy 135 mg/dL without taking any medication and only by going on a plant-based diet.

He lost 10 pounds (4.5 kg) within a month of adopting this diet.

He said:

“I wake up every day eager to hear about how a plant-based diet and a healthful lifestyle is changing and saving lives in our community.

What I’ve found is that if you want your patients to make significant health changes, you have to make them yourself.

The prescription started to spread soon after my family, co-workers, neighbors, and friends heard about my experience.”

High blood cholesterol levels and triglycerides can lead to hyperlipidemia which often is not diagnosed and so left untreated.

If only 10 percent of patients with hyperlipidemia are treated this could save 8,000 lives every year.

Making lifestyle and dietary changes even in small steps could avert 10,000 cases of heart disease in the US, 20,000 heart attacks, and three billion dollars of medical expenses every year.

Ms Levin said:

“To make any form of health care work and to truly power economic mobility, we have to get healthy.

The first place to start is by building meals around nutrient-packed, plant-based foods, which fit into nearly every cultural template, taste preference, and budget.”

The study was published in Nutrition Reviews (Yokoyama et al., 2017).

The pill contains natural substances that help lower “bad” cholesterol in an effective way.

A plant sterols and stanols (PSS) pills can reduce low-density lipoprotein (LDL), the so-called “bad” cholesterol.

Daily dietary supplementation of PSS from 1.5 to 3 g  has been shown to lower LDL cholesterol by 7.5 percent to 12 percent, a review of different studies concludes.

One study found that 1.8 g of soy stanols pills over the course of 6 weeks could reduce bad cholesterol by nearly 10 percent.

Professor Anne Carol Goldberg, the study’s first author, said:

“Those who started with higher LDL got a bigger response, a bigger drop in their LDL, when they added plant sterols to their regimen.”

PSS, also known as phytosterols or plant steroids, are natural substances that are produced by plants.

Nuts, seeds, whole grains, vegetables, legumes, fruits, and vegetable oil-based margarines contain good amounts of PSS.

Phytosterol dietary supplements and phytosterol-enriched foods have been sold for decades.

The National Cholesterol Education Program advises that people with high cholesterol should consume foods containing plant sterols, because of its effect on reducing the risk of cardiovascular disease.

PSS have a similar structure to cholesterol and compete with cholesterol to get absorbed.

This happens in such a way that it lowers the absorption of cholesterol in the gut and so they cannot be transported into the blood.

But PSS are not easily absorbed in the intestine unless they have been dissolved in something absorbent in the intestine.

Margarine is one sterol-containing food that has been found to lower LDL cholesterol, as well as some juices and puddings which have added plant sterols.

One or two tablespoons of sterol-containing margarine per day could reduce LDL cholesterol considerably.

However, these types of sterol-containing foods can be inconvenient for some patients or those who need to lose weight.

Professor Goldberg said:

“One problem is many of our patients already have lowered their intake of fats and calories and don’t use products like margarine on a regular basis.

In addition, many of these people eat out regularly, and they can’t easily take a particular brand of margarine to a restaurant.”

Consequently, the sterols in pill form can be a practical and helpful option but to see the benefits, they should be consumed with a proper meal such as breakfast, lunch or dinner and preferably twice a day.

The review was published in the Journal of Nutrients (Elke et al., 2018) and the study was published in the American Journal of Cardiology (Goldberg et al., 2006).

As well as lowering cholesterol, this food improves cardiovascular health.

Eating soybeans can lower cholesterol, research finds.

Soybeans also contain lecithins, isoflavones and fiber, which have cardiovascular benefits.

Soy protein has the ability to reduce ‘bad’ (LDL) cholesterol by a small amount.

Statistical analysis of 41 studies shows that a daily intake of 25 grams of soy protein can lower LDL cholesterol by 4% within 6 weeks.

Accumulation of LDL cholesterol in the arteries can cause blockages and a sudden blood clot, which can lead to a heart attack or stroke.

Dr. David Jenkins, the lead author of this study, said:

“When one adds the displacement of high saturated fat and cholesterol-rich meats to a diet that includes soy, the reduction of cholesterol could be greater.”

Soybeans are rich in fibres and phytochemicals, such as isoflavones, phytosterols and lecithins, which independently or together have unique health benefits.

Isoflavones are associated with a reduction in the incidence cardiovascular disease (CVD) in menopause women and menopausal symptoms by mimicking the effect of a primary female sex hormone called estrogen.

Between 25 and 375 mg daily of soy isoflavones for 1–12 months has been shown to lower blood pressure.

Soy lecithins have a role in lipid metabolism by improving the break down of fat or using storage of fats in cells for energy.

Soy fibers have been shown to improve weight loss in overweight and obese adults after a 12-week period.

Studies have also found that soy protein has anti-inflammatory effects, possibly due to the ability of amino acids in soy protein to reduce inflammation.

The US Food and Drug Administration (FDA) is planning to remove soy from its heart-healthy food health claims list.

However, the studies above confirm the effect of soy protein on lowering LDL cholesterol.

Dr. David Jenkins, the lead author of study conducted by St. Michael’s Hospital in Toronto, said:

“The existing data and our analysis of it suggest soy protein contributes to heart health.

We hope the public will continue to consider plant-based diets as a healthy option.”

The first study was published in The Journal of Nutrition (Mejia et al., 2019) and the second was published in Nutrients (Ramdath et al., 2017).

A common side-effect of taking cholesterol-lowering drugs and how to get rid of it.

Statins are drugs that target the ‘bad’ cholesterol in the blood to try and reduce it.

Lowering the fatty substance can help to decrease the risk of hearth disease and stroke.

While the drugs are generally well-tolerated, there are a number of side-effects.

These can depend on the exact type of statin.

For people taking atorvastatin, though, one relatively common side-effect is myalgia, which means muscle pain.

Taking atorvastatin sometimes causes inflammation and damage to muscles, which is the cause of muscle pain.

If you are experiencing a side-effect like this, it is best to see your doctor and they may choose to do a blood test.

The blood test can help to determine if there are elevated levels of creatine kinase in your body.

Creatine kinase is a substance released when the muscles are damaged.

If the levels are elevated, your doctor may choose to take you off the statins for a period until the creatine kinase levels return to normal.

Then, later they may put you back on statins at a lower level.

Another way of avoiding muscle pain from taking statins is to do a little exercise (Lotteau et al., 2019).

Other common side-effects of statins include are headaches, stomach pain, dizziness, constipation and feeling sick.

In addition, some people taking the cholesterol medication report pins and needles in their hands and feet.

Alternatives to taking statins

Because of the side-effects of statins, researchers are looking for alternatives to lower cholesterol.

One method which has recently attracted attention is the use of natural foods with cholesterol-lowering properties.

One study gave patients foods with real ingredients, such as walnuts, dark chocolate and smoothies containing strawberries and bananas.

The foods used typically have high levels of plant sterols, fibre, omega-3 fatty acids and antioxidants.

The results showed that cholesterol levels were decreased by 9 percent on average in three days, with some seeing reductions of 30 percent.

The study was published in the Journal of Nutrition (Kopecky et al., 2022).

Genetic evidence reveals the effect drinking milk has on cardiovascular disease and type 2 diabetes.

A high intake of milk won’t increase cholesterol levels, according to a large study of 2 million people.

In fact, those who drank milk every day had lower levels of bad (LDL) cholesterol than non-milk drinkers.

Moreover, higher intakes of milk were associated with a 14 percent reduced risk of coronary heart disease and an 11 percent reduced risk of type 2 diabetes.

Increased consumption of high-fat dairy, due to their saturated fat content, may have negative effects on cardiovascular health.

Saturated fats have been associated with high blood cholesterol and cardiovascular disease (CVDs) risk.

However, several studies have found that consumption of milk and low-fat dairy products lead to lower cholesterol levels and lower risk of CVDs.

This study examined the effect of milk intake on cardio-metabolic risk (risk factors for developing cardiovascular diseases and diabetes) using a genetic approach by looking at the lactase gene variant.

Lactase is a digestive enzyme which breaks down lactose, a sugar found in milk and milk products.

The enzyme is encoded by the lactase (LCT) gene.

The team found that people who drink higher amounts of milk have the genetic variation that digests lactose.

Professor Vimal Karani, the study’s lead author, said:

“We found that among participants with a genetic variation that we associated with higher milk intake, they had higher BMI, body fat, but importantly had lower levels of good and bad cholesterol.

We also found that those with the genetic variation had a significantly lower risk of coronary heart disease.

All of this suggests that reducing the intake of milk might not be necessary for preventing cardiovascular diseases.”

The reasons that high milk intake can lower cholesterol levels might be related to:

• Calcium and lactose in milk influencing fat metabolism.
• Compared to other dairy foods, milk is low in fat but people with lactose intolerance, to get their calcium intakes, tend to eat high fat dairy products which contain higher amounts of cholesterol.
• Calcium intake from foods such as milk enhances bile acid  removal and so causes hepatic cholesterol to generate bile acids, consequently this process leads to a reduction of cholesterol levels.
• Gut microbial fermentation of indigestible carbohydrates such as lactose can affect cholesterol production causing cholesterol levels to drop.

Professor Vimal Karanis aid:

“The study certainly shows that milk consumption is not a significant issue for cardiovascular disease risk even though there was a small rise in BMI and body fat among milk drinkers.

What we do note in the study is that it remains unclear whether it is the fat content in dairy products that is contributing to the lower cholesterol levels or it is due to an unknown ‘milk factor’.”

The study was published in the International Journal of Obesity (Vimaleswaran et al., 2021).

High cholesterol can lead to heart disease and other health problems.

When it comes to lowering cholesterol, it is wise to cut down on both white meat and red meat.

The idea that white meat, such as chicken, is healthier than red meat, such as pork, beef or lamb, is a myth.

In fact, white poultry is just as bad as red meat for blood cholesterol levels.

Eating high amounts of red meat or white meat increases the low-density lipoproteins (LDL) known as “bad” cholesterol, a new study has found.

The researchers examined 3 dietary proteins; red meat versus white meat and non-meat protein foods.

The results showed that white poultry, as well as red meat, raised blood cholesterol compared to non-meat protein sources.

Dr Ronald Krauss, the study senior author, said:

“When we planned this study, we expected red meat to have a more adverse effect on blood cholesterol levels than white meat, but we were surprised that this was not the case — their effects on cholesterol are identical when saturated fat levels are equivalent.”

They also noticed that the increased blood cholesterol was not affected by whether the diet was high in saturated fats.

LDL contains different sized particles and high amounts of saturated fat can increase concentrations of large LDL particles.

Standard LDL cholesterol levels are used to measure the chance of cardiovascular disease, but LDL cholesterol tests mainly reflect larger LDL particle levels.

Therefore, this can lead to overestimating the effect of saturated fat intake on cardiovascular disease.

In recent years, due to the link between red meat intake and increased heart disease, the consumption of poultry as a healthier option to red meat has been encouraged.

But until now there has not been any inclusive study to compare the effects of red meat, white meat and non-meat proteins on blood cholesterol, Dr Krauss said.

Non-meat proteins such as dairies, legumes and vegetables should lower bad cholesterol the most.

He also noted that the study didn’t include fish or processed meats, such as sausage or bacon.

Dr Krauss said:

“Our results indicate that current advice to restrict red meat and not white meat should not be based only on their effects on blood cholesterol.

Indeed, other effects of red meat consumption could contribute to heart disease, and these effects should be explored in more detail in an effort to improve health.”

The study was published in The American Journal of Clinical Nutrition (Bergeron et al., 2019).