Functional Foods that Lower Cholesterol

• Several functional foods have been found to improve health and reduce risk including lowering of LDL-C. FDA has recognized LDL-lowering health claims for plant sterols(5%),  viscous fiber (4%), nuts and soy proteins with a combination of all four decreasing LDL-C by 13-14%.¹

• Phytosterols compete with cholesterol for intestinal absorption thus modulating cholesterol levels.^{1, 2} Daily consumption of 2g of phytosterols per day can lower LDL-C by 5-10%.^{1, 3}

• Phytosterols and ezetimibe can be used together without adverse interaction and that their fundamental effects on whole-body cholesterol metabolism complement one another.⁴

• The principle phytosterols are sitosterol, campesterol, and stigmasterol. They occur naturally in oils and in smaller amounts in vegetables, fresh fruits, chestnuts, grains, and legumes. The dietary intake of plan sterols ranges between an average of 250 mg/d in northern Europe to 500 mg/d in Mediterranean countries.

• Phytosterols have been added to spreads and vegetable oils (functional margarine, butter, and cooking oils) as well as yogurt and other foods without losing its cholesterol lowering efficacy. It is usually given as sterol-enriched margarine.¹

• Soy protein (in the form of soy milk, soy meat analogue or Tofu) has modest LDL-C lowering effect (3-5%) and can be used as a substitute for animal proteins.^{1, 5, 6}  Both soy and milk protein also lower blood pressure (2 mm Hg). Thus  partially replacing carbohydrate with soy or milk protein might be an important component of nutrition intervention strategies for the prevention and treatment of hypertension.⁷

• Dietary fiber, especially soluble fiber from oat bran, barley, beta-glucan, and psyllium, is recommended for LDL-C lowering at a daily dose of 5-15g/d.^{8, 9} This can also be used as foods enriched with these fibers.⁸

• Epidemiological studies have consistently associated nut consumption with reduced risk for coronary heart disease. Nut consumption improves blood lipid levels in a dose-related manner, particularly among subjects with higher LDL-C or with lower BMI. The effects of nut consumption are e dose related, and different types of nuts had similar effects on blood lipid levels.¹⁰

• With a mean daily consumption of 67 g of nuts, the following estimated mean reductions were achieved: LDL-C10 mg/dL and ratio of total cholesterol concentration to HDL-C (0.24).  Triglyceride levels were reduced by 21 mg/dL in subjects with blood triglyceride levels of at least 150 mg/dL.¹⁰

• Omega-3 unsaturated fatty acids from marine sources (DHA and EPA) can lower triglyceride levels 25-30% at a dose of 3g per day in people with high triglycerides, but may increase the LDL by 5%. Plant sources of omega-3 such as alpha-linolenic acid present in chestnuts, some vegetables, and seed oils is less effective in lowering triglycerides.³

• Policosanol is a natural mixture of long chain aliphatic alcohols extracted primarily from sugar cane wax. Contrary to common belief, policosanol from sugar cane, rice, or wheat germ has no beneficial effect on lipids.¹¹

• Red rice yeast (RYR) is a source of fermented pigment used in China as a food colorant and flavor enhancer for centuries. It can lower LDL-C by a statin like mechanism but the various preparations have markedly different content of biologically active ingredients, predisposing to serious toxicity to the liver, kidneys, and muscles.

• Other herbal and natural agents that have been studied to lower cholesterol and remain controversial include policosanol, flax seed, eggplant extract, garlic, Guggulipid and chromium.

Sources

1. Jenkins DJ, Jones PJ, Lamarche B, et al. Effect of a dietary portfolio of cholesterol-lowering foods given at 2 levels of intensity of dietary advice on serum lipids in hyperlipidemia: a randomized controlled trial. JAMA. Aug 24 2011;306(8):831-839.

2. Katan MB, Grundy SM, Jones P, Law M, Miettinen T, Paoletti R. Efficacy and safety of plant stanols and sterols in the management of blood cholesterol levels. Mayo Clin Proc. Aug 2003;78(8):965-978.

3. Catapano AL, Reiner Z, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Atherosclerosis. Jul 2011;217 Suppl 1:1-44.

4. Hu FB. Do functional foods have a role in the prevention of cardiovascular disease? Circulation. Aug 2 2011;124(5):538-540.

5. Jenkins DJ, Mirrahimi A, Srichaikul K, et al. Soy protein reduces serum cholesterol by both intrinsic and food displacement mechanisms. J Nutr. Dec 2010;140(12):2302S-2311S.

6. Huang J, Frohlich J, Ignaszewski AP. The impact of dietary changes and dietary supplements on lipid profile. Can J Cardiol. Jul-Aug 2011;27(4):488-505.

7. He J, Wofford MR, Reynolds K, et al. Effect of dietary protein supplementation on blood pressure: a randomized, controlled trial. Circulation. Aug 2 2011;124(5):589-595.

8. Anderson JW, Allgood LD, Lawrence A, et al. Cholesterol-lowering effects of psyllium intake adjunctive to diet therapy in men and women with hypercholesterolemia: meta-analysis of 8 controlled trials. Am J Clin Nutr. Feb 2000;71(2):472-479.

9. Brown L, Rosner B, Willett WW, Sacks FM. Cholesterol-lowering effects of dietary fiber: a meta-analysis. Am J Clin Nutr. Jan 1999;69(1):30-42.

10. Sabate J, Oda K, Ros E. Nut consumption and blood lipid levels: a pooled analysis of 25 intervention trials. Arch Intern Med. May 10 2010;170(9):821-827.

11. Reiner Z, Tedeschi-Reiner E, Romic Z. Effects of rice policosanol on serum lipoproteins, homocysteine, fibrinogen and C-reactive protein in hypercholesterolaemic patients. Clin Drug Investig. 2005;25(11):701-707.