A dietary pattern that is low in animal fats, and high in whole grains, fruits, vegetables, nuts, seeds and legumes has been linked with protecting the heart, but particular foods and nutrients offer special promise for keeping cholesterol levels in check.
'All food is functional, but some foods have positive health benefits beyond basic nutrition,' explains Joan Salge Blake, M.S., R.D., dietitian and spokesperson for the American Dietetic Association, speaking about the role of foods and nutrients in heart health. Since heart disease is a major public health concern (almost 50 percent of American adults have high cholesterol levels over 200 mg/dL, a major risk for heart disease), the Food and Drug Administration (FDA) has approved a number of heart health claims on food labels that pertain to certain nutrients found in both whole foods and supplements. These include soluble fiber, omega-3 fatty acids, plant stanols and sterols, and soy protein. Though other functional foods and nutrients, like red yeast rice, garlic and niacin, show some evidence of cholesterol-lowering effects, they have not been supported yet by FDA health claims.
EN takes a closer look at functional foods and supplements linked with heart health.
* Soluble fiber. Oats, barley and psyllium husk all contain soluble fiber, which forms a gel-like substance in your intestines and binds with excess cholesterol to help rid it from your body. Because of this, the FDA has approved health claims that state 3 grams (g) of soluble fiber per day from oats and barley and 7 g per day from psyllium seed husk, as part of a diet that is low in saturated fat and cholesterol, can provide heart health benefits. A September 2010 study in the Journal of Clinical Gastroenterology concluded that soluble fiber found in oats, barley and specifically, psyllium husk, help reduce total cholesterol, triglyceride levels and blood pressure; in addition, the fiber makes you feel full faster, an advantage in weight control.
* Omega-3 fatty acids. Fish, krill (tiny shrimp-like crustaceans), and algae oil all contain omega-3 fats, which have been praised for their ability to lower triglycerides and raise HDL ('good') cholesterol levels.
Blake explains that if you eat more fish, you displace the amount of meat you eat, thus lower the amount of unhealthy saturated fats in your diet. Although the FDA does not regulate supplements, it has recommended safe limits of 3,000 milligrams (mg) per day for omega-3 fats from fish and supplements combined, and 2,000 mg per day from supplements alone due to potential risks, such as internal bleeding. Keep in mind that dietary supplements are not approved for safely or effectiveness by any government organization. In fact, a recent review by ConsumerLab.com, an independent organization that analyzes nutrition products, evaluated 24 omega-3 supplements and found that only 17 passed tests for purity, freshness and the correct dosage of omega-3 listed on the packaging.
* Plant stanols and sterols. Plants have powerful compounds called plant stanols and sterols that block the absorption of cholesterol from the intestines. Studies reveal that 2 g per day can lower LDL ('bad') cholesterol by 5 to 15 percent within weeks. Although fruits and vegetables are a great source, you'd need to eat a lot of them to see results, however. Fortified products, such as Benecol[R] or Take Control[R] margarine and orange juice, are available. As far as plant stanols/sterols supplements, ConsumerLab.com reviewed and approved seven out of eight plant sterol ester supplements tested. CholestaPRO was not approved, because the pill didn't list the right dosage on the label and didn't disintegrate after six hours, suggesting that it passes through the body without releasing its beneficial plant sterols.
* Soy Protein. From the soybean comes a powerful protein that has proven beneficial in lowering total cholesterol and LDL cholesterol, while raising HDL cholesterol. The FDA has approved a health claim for soy protein that indicates 25 g per day, along with a diet low in saturated fat and cholesterol, may reduce the risk of heart disease. One serving of soy foods, such as 1 cup soy milk or one-half cup of tofu, soybeans or edamame, provides at least 6.25 g soy protein.
* Red yeast rice. Red yeast rice contains a natural, cholesterol-lowering compound called monacolin-K, also known as lovastatin, the same substance found in prescription statin drugs. Studies have shown that taking red yeast rice daily for two to three months lowers total and LDL cholesterol and triglyceride levels. In a 2008 study in China, people with previous heart attacks who took red yeast rice lowered their risk of heart attack-related deaths by 30 percent and the need for heart surgery by one-third; in addition, there was a 20 percent decrease in LDL cholesterol and a four percent increase in HDL cholesterol (American Journal of Cardiology, April 2008.)
Unfortunately, there is a big problem with lack of uniformity in types and amounts of monacolins found in red yeast rice supplements. In fact, ConsumerLab.com reviewed 10 red yeast rice supplements and found that monacolin amounts varied more than one hundred-fold in these products. Since they are not standardized, the National Institutes of Health suggests that there is better evidence in favor of taking prescription statin drugs to lower cholesterol. (See EN December 2010 'Red Yeast Rice: Natural Hearth Health Supplement or Drug?')
* Niacin. Also known as Vitamin B3, niacin has shown to be effective at improving cholesterol levels, but in high supplemental doses, ranging from 1,000 to 4,000 mg per day. The catch: At this level niacin may be harmful to the liver. While it won't hurt to eat niacin-rich foods, like peanuts, brown rice, fish and meat, be aware that these sources probably won't contribute enough niacin to affect cholesterol levels.
* Garlic. This flavorful plant food may have medicinal properties, especially when it comes to heart health. Fresh, dried or powdered garlic may slow hardening of the arteries or atherosclerosis. Garlic has shown short-term reductions in total cholesterol by four to 12 percent, as well as triglycerides and LDL cholesterol. Although garlic has been shown to be beneficial for cholesterol levels, don't put your faith In just one food. Some research has shown that garlic by itself may not bring down cholesterol levels significantly. Yet, it can't hurt to season your food with the delicious flavors of garlic. Keep in mind that while even high doses of garlic appear to be safe, garlic supplements may interact with medications, such as birth control pills, cyclosporine, protease inhibitors and blood thinners like Coumadin. Consult your health care provider before taking any dietary supplements.
Caution with omega-3 Supplements
Sure, omega-3s are a good thing, but you still need to be cautious and consult your health care provider before taking fish oil supplements, especially if you are:
* Taking blood thinners (such as Coumadin,) as high levels of omega-3s may potentially cause internal bleeding.
* Immune-compromised, because high doses (over 3,000 mg per day) may suppress your immune system.
* Allergic to fish or krill, since labels may not reflect if the product contains any potential allergens.
* Taking blood pressure medications, because fish oil supplements may lower blood pressure even more.
--Victoria Shanta Retelny, R.D.
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