Continuing on last week's theme of ways that we can naturally lower our cholesterol, today we'll explore 3 additional ways that we can lower our LDL cholesterol and ApoB through food. If you haven't read part 1, go back and read it here. Keep an eye out for our next article on Lp(a), an independent marker of heart disease risk, and what you can do to lower it.
While stress management, daily exercise, sleep habits, and positive social connections can reduce our risk of cardiovascular disease (ie, heart attack and stroke), the foods that we choose to eat each day have, by far, the largest influence. So what can we do to reduce our risk? According to the peer-reviewed scientific literature:
Following the Portfolio diet can reduce our risk close to that of a low-dose statin,
Avoiding or reducing saturated fat in our diet can have the largest overall impact,
Avoiding cholesterol can make a difference (none versus some makes the biggest difference),
And Indian Gooseberry (Amla), a dried fruit, could perceivably lower cholesterol comparably to a low-dose statin (around 1/8 of a tsp per day). There are risks.
Disclaimer: This is not medical advice. The following information are meant for entertainment and education purposes only and should not be used to diagnose or treat any medical condition nor should they be used as a substitute for medical advice from a qualified, board-certified practicing clinician. Always consult your health care provider before making changes to your diet and/or lifestyle.
What does the science say?
The Portfolio Diet

Portfolio diet (reduces LDL by 29%)
The 4 core food components of the Portfolio dietary pattern include (based on a 2000 kcal diet):
42 g nuts (tree nuts or peanuts)
50 g plant protein from soy products or dietary pulses such as beans, peas, chickpeas, and lentils
20 g viscous soluble fibre from oats, barley, psyllium, eggplant, okra, apples, oranges, or berries
2 g plant sterols (vegetables, fruits, wheat germ, whole grains, beans, sunflower seeds, and many vegetable oils)
1 fist sized avocado and 2 tablespoons of olive oil (or 4 tablespoons of non-tropical vegetable oil)
A background diet that is low in saturated fat (butter, milk, eggs and dairy).
Up to 2 eggs per week
Reduce Saturated Fat Intake

Reduce Saturated Fat (reduces LDL in a linear dose response relationship)
Saturated fat increases LDL cholesterol and Apolipoprotein B (ApoB) raising our risk for cardiovascular disease (ie, heart attack and stroke) (9).
According to the National Academies of Sciences (formerly, the Instute of Medicine), the tolerable upper intake for saturated fat is none (9). Any intake at all raises our cardiovascular risk (9).
It's crucial to understand that while our genetics influence our baseline LDL cholesterol level, controlled feeding studies show a predictable change with dietary intervention. There's just too much to much to cover about this, so I'll let Dr. Michael Gregor (Faculty at the American College of Lifestyle Medicine) explain in this short 8 minute video.
Reduce Dietary Cholesterol

Reduce Dietary Cholesterol (highly related to how much we are already eating with lots of genetic variation in how much is absorbed from our food)
Eggs are one of the primary sources of dietary cholesterol (4)(10).
Most of us absorb about 50-60% of the dietary cholesterol that we eat (6), but genetic influences (genes) can alter this absorption to a range of 20-80% (7).
While saturated fat consumption has a much more potent effect on raising LDL cholesterol in the blood and should be our focus, dietary cholesterol does make a difference, albiet much smaller. According to a recent meta-analysis, Egg consumption of 1or more eggs per day, does increase Apo(b), a marker of LDL cholesterol (4).
An article dating back to 1961 evaluated the effect of adding cholesterol to the diet compared to a "cholesterol free diet", showing that dietary cholesterol can indeed raise our levels (5). See chart below (5).
The confusion appears when we compare adding dietary cholesterol (eggs) to a background diet that already includes meat, dairy and eggs (sources of dietary cholesterol and saturated fat). Adding more cholesterol to a diet that is already rich with cholesterol, does raise our levels, but not to a large degree (4). So, if we are not reducing our saturated fat intake (found in meat, dairy, butter and eggs -- foods which also have cholesterol in them [10]), then removing eggs from the diet doesn't make a huge difference. That's why focusing on reducing our saturated fat intake is so important as a first step, and once we've made it this far, removing eggs from the diet can be an additional option.

Alma (Indian gooseberry)

Amla (powered Indian Goose Berries from the local natural foods store)
Note of caution: Studies have compared Amla to Aspirin and Plavix (Clopidogrel) finding that it increases the risk of bleeding (although not even close to as effectively as these medications and is not a suitable alternative). Amla is not recommended for anyone who is already taking medications that increase the risk of bleeding or people with bleeding disorders or known blood loss. Those of us taking chronic NSAIDs fall into this category of people at risk for bleeding. Amla is not potent enough to replace Aspirin or Plavix. Do not take if pregnant or breastfeeding. May likely also reduce blood pressure, so caution needs to be taken with those of us taking blood pressure lowering medications. (1)
Compared to low-dose Atorvastatin 10 mg once daily over 12 weeks, Amla reduced both LDL cholesterol and high-sensitivity C- Reactive Protein (hr-CRP), although again, not quite as potently as the low-dose statin. We also saw improvement in A1c by on average drop of 0.5% in those taking Amla and low-dose Atorvastatin. (2)
Compared to low-dose Simvastatin 20 mg once daily for 6 weeks, Amla reduced both LDL cholesterol and blood pressure. (3)
My Thoughts

What do I think? Having worked as a Primary Care Provider (PCP) and previously as an Emergency Room Nurse at two of the largest medical centers in Maine, I've seen first hand not only the heart attacks and strokes caused by decades of unknowingly poor dietary choices, but also the changes in independence and quality of life that comes as a consequence of cardiovascular disease. I think that most of us start to focus on the markers of cardiovascular disease in our 50's, 60's and 70's, when our risk is highest, but we know that this risk is accumulated over decades (with studies suggesting that atherosclerosis can begin as early as in the womb). If this is you, it is never to late to start making a change.
Having seen the consequences, they motivated me to change my own dietary pattern (which was previously centered on ultra-processed foods; mostly candy). They even motivated me to go back to school and learn even more about the connection between diet and health. I made the change towards a plant predominant dietary pattern for both my husband, and myself in our 30's. I also helped my parents to transition on the dietary spectrum towards a plant predominant eating pattern because I want them to be around long enough to see and keep up with their grandchildren. I've been priviledged to counsel patients and I've helped them to sucessfully reduce their risk factors.
I think that if more medical providers understood and practiced reducing our own risk factors, that this would lead to more conversations about dietary pattern in day-to-day clinic visits. Most of us aren't receiving dietary counseling in the clinic because either our clinicians don't know the data or are struggling to make changes themselves. In the famous words of Cardiologist Dr. Williams, "There are two kinds of cardiologists: vegans, and those who haven't read the data.”
If you're interested in or are struggling to reduce your cardiovascular risk factors, then schedule a free new patient consultation and walk away with a plan to get back on the right track. Jessica Krol, FNP, DipACLM of Lifestyle Medicine Maine will not only show you the evidence-based literature behind her recommendations, she will help you to caculate your risk and guide you along the dietary spectrum to create lasting habits. Dietary changes are not a zero sum game. Any dietary change in the right direction can improve our risk. There is a role for both cholesterol lowering medications (statins) and dietary changes in combination. Know your risk and what to do about it.
Why Join Our Weight Loss and Wellness Program?
Starting on October 6th at 9 AM EST, our 12-week live group program is meticulously designed for individuals determined to lower cholesterol levels and enhance overall wellness. Here's what our program can provide:
Professional Guidance: Our experts in lifestyle medicine deliver personalized advice and strategies, empowering you to make informed health decisions.
Community Support: You'll be part of a community of peers who understand your challenges and share your health goals, offering mutual encouragement and accountability.
Effective Strategies: Discover scientifically-supported dietary and lifestyle changes that not only reduce inflammation but also promote long-term sustainable health.
Program Details
This engaging and interactive program ensures that you gain both the knowledge and practical skills necessary to see tangible improvements. Session 04 is an excellent opportunity for you to proactively manage your inflammatory markers and overall health.
How to Join
With limited spaces available, we ensure personalized attention for each participant, providing the tailored support and guidance you need. Note that the Live Group Program is exclusively for Maine State Residents.
Out of state residents can explore the Self Guided Weight Loss and Wellness Program.
Interested in learning more or ready to take the first step? Reach out through our website to send a message or book a free consultation today. This program is more than just education—it's your path to a healthier life.
Sign up now to secure your spot in our upcoming session and begin your journey to reducing inflammation and enhancing wellness.
We look forward to assisting you in lowering your cholesterol and guiding you every step of the way on your journey to optimal health.
References
Study of pharmacodynamic interaction of Phyllanthus emblica extract with clopidogrel and ecosprin in patients with type II diabetes mellitus. Fatima et al. Phytomedicine. (2014) 10.1016/j.phymed.2013.10.024
Effects of Phyllanthus emblica extract on endothelial dysfunction and biomarkers of oxidative stress in patients with type 2 diabetes mellitus: a randomized, double-blind, controlled study. Usharani et al. Journal Diabetes, Metabolic Syndrome and Obesity. (2013) 10.2147/DMSO.S46341
A comparative clinical study of hypolipidemic efficacy of Amla (Emblica officinalis) with 3-hydroxy-3-methylglutaryl-coenzyme-A reductase inhibitor simvastatin. Gopa et al. Indian Journal Pharmacology. (2012) 10.4103/0253-7613.93857
The responses of different dosages of egg consumption on blood lipid profile: An updated systematic review and meta-analysis of randomized clinical trials. Sikaroudi, et al. Journal of Food Biochemistry. (2020) https://doi.org/10.1111/jfbc.13263
The serum lipids in mane receiving high cholesterol and cholesterol-free diets. Connor et al. Journal of Clinical Investigation. (1961) 10.1172/JCI104324
Phytosterols, Cholesterol Absorption and Healthy Diets. Ostlund. Journal Lipids (2007) https://link.springer.com/article/10.1007/s11745-006-3001-9
Dietary cholesterol: from physiology to cardiovascular risk. Lecerf et al. British Journal of Nutrition. (2011) 10.1017/S0007114511000237
Identification of Top Food Sources of Various Dietary Components. National Cancer Institute. NIH. (2010) https://epi.grants.cancer.gov/diet/foodsources/top-food-sources-report-02212020.pdf
Tolerable upper intake levels for trans fat, saturated fat, and cholesterol. Trumbo et al. Journal of Nutrition Reviews. (2011) 10.1111/j.1753-4887.2011.00389.x
Egg, hard boiled, cooked, whole. Nutrition Value. (n.d.) https://www.nutritionvalue.org/Egg%2C_hard-boiled%2C_cooked%2C_whole_nutritional_value.html
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