Bile acid sequestrates (Questran, Prevalite, Colestid, Welchol), known as BAS, are utilized to lower elevated LDL cholesterol and are often prescribed for those with elevated cholesterol levels. LDL cholesterol is known as the ‘bad’ cholesterol because it is responsible for bringing cholesterol from the liver into the bloodstream where it has potential to be deposited along the arterial walls.
Many dietary alternatives do exist which can decrease levels of LDL cholesterol without the common side effects of BAS, which include GI distress, gallstones, and heartburn. Soluble fiber is one such well-known supplement that has been proved to reduce cholesterol. Oat fiber, psyllium, and pectin have all shown to reduce levels; 10-30 grams of soluble fiber per day can decrease LDL by 10% (Brown, Rosner, Willett, & Sacks, 1999; Rosenthal, 2000), which can be the difference between one’s doctor pushing for medication vs. offering congratulations for some people. 1/4 cup of oat bran contains 4 grams of fiber, of which 3 grams are soluble. Add 2 tablespoons of ground flax seeds (6 grams of soluble fiber) and you are well on your way to a healthier cholesterol ratio!
Plant sterols are believed to lower serum cholesterol by inhibiting absorption. To make plant sterols more accessible to the public, a margarine containing sitostanol ester was manufactured and has been studied. 2-3 servings of this margarine per day appear to lower LDL levels by 14% after a year of consumption and was well-tolerated by subjects (Miettinen, Puska, Gylling, Vanhanan & Vartiainen, 1995). While the study was well executed, it is unknown if funding for this research was supplied by the margarine manufacturer, which may influence data. Also of note, these products often contain corn syrup as well as trans-fatty acids, both of which increase inflammation and can contribute to disease over time. However, plant sterols are also found in wheat germ, wheat bran, peanuts, vegetable oils (corn, sesame, and olive oil), almonds and Brussels sprouts. Smaller amounts are found in other vegetables, but it is a challenge to get enough plant sterols from foods, which is why this margarine was created in the first place. That said, plant sterols are available in supplement form; you’ll want to talk to your healthcare provider before taking a phystosterol supplement, however.
Olive oil, while not directly lowering LDL levels, may offer complementary benefit by changing the composition of LDL particles in the body. 50 grams of olive oil a day (about 4 tablespoons) appears to reduce the risk of LDL oxidation, which can reduce the potential of LDL to lead to atherosclerosis (Aviram & Eias, 1993). Oxidation is a big factor in whether or not cholesterol will remain benign or turn deadly; the best way to prevent oxidation is to include lots of green vegetables, olive oil, and choose slow cooking methods for meats over grilling or frying.
Resources:
Aviram M., Eias K. (1993) Dietary olive oil reduces low-density lipoprotein uptake by macrophages and decreases the susceptibility of the lipoprotein to undergo lipid peroxidation. Annals of Nutrition and Metabolism, 37(2), 75-84.
Brown L., Rosner B., Willett W.W., Sacks, F.M. (1999) Cholesterol-lowering effects of dietary fiber: a meta-analysis. American Journal of Clinical Nutrition, 69(1), 30-42.
Miettinen TA, Puska P, Gylling H, Vanhanan H, Vartiainen E. (1995) Reduction of serum cholesterol with sitostanol-ester margarine in a mildly hypercholesterolemic population. New England Journal of Medicine, 333,1308–1312.
Rosenthal, R.L. (2000) Effectiveness of altering serum cholesterol levels without drugs. Proceedings (Baylor University. Medical Center), 13(4), 351–355.
