Q. I’m “paying my dues” taking vitamins, exercising, and sticking to a low-fat and low-cholesterol diet, but my serum cholesterol still hovers around 240, and my HDL cholesterol won’t go over about 40. My triglycerides and LDL cholesterol are OK. What more could I do to improve those other two numbers?
A. Evidence is mounting that the type of fat you eat may be as important as the amount of dietary fat in keeping your blood lipid profile (total cholesterol, LDL cholesterol, HDL cholesterol, and triglyceride levels) satisfactory. Emphasis on monounsaturated fats and fats in the omega-3 polyunsaturated family seems capable of offsetting some fudging on the total amount of fat.
Consider the results of a recent experiment reported in the Journal of Nutrition. Subjects were assigned to eat either the diet recommended by the American Heart Association or the same diet with 20% of the calories replaced with calories from pecans, which are an excellent source of monounsaturated and omega-3 fats. This change increased the total fat content from 28% to 39%, or approximately from the amount recommended by American Heart Association to the amount in the typical American diet. Once each subject’s lipid profile was stabilized on one diet, they were switched to the other diet so that each subject was his or her own match.
The blood lipid profile for each subject improved on both diets, which indicates that we would all do better if we limited total fat to about 30% of calories. However, the diet with pecans, even though considerably higher in total fat calories, did about 10% better than the other diet when it came to improving the lipid profile.
One of the problems with a low fat diet is poor compliance. We hunger for a certain amount of fat and may even overeat low fat foods (and gain weight) because low fat foods are not as satisfying. Allowing more of the right kind of fat may keep some people on their diet. Nuts (not peanuts, which are legumes and not nuts) supply the right kind of fats, and research indicates that five ounces of nuts per week reduces the risk of heart attack.
Diet is important and not to be ignored, but it is not the only way to improve your lipid profile. Even though you “take your vitamins” you may not know of a form of vitamin E that seems to work as well as the common cholesterol-lowering drugs. This vitamin E, called tocotrienol, is about 60 times more potent than the tocopherol form that we have used for decades. The so-called “statin” drugs lower cholesterol by inhibiting an enzyme, HMG-CoA reductase, which is needed to synthesize cholesterol. One problem is that, in response to the drugs, the body increases HMG-CoA reductase production by about 200-fold in an effort to circumvent the inhibition. Tocotrienol does not inhibit HMG-CoA reductase production but enhances its rate of its destruction and so does not trigger an increase in production. As little as 35 milligrams of “mixed tocotrienols” per day can be effective in doing just what you need done (lowering total and raising HDL cholesterol), but it has been safely used in much larger amounts (300-600 milligrams per day) in treatment of breast cancer.
The effect of dietary cholesterol intake is still controversial, with some research indicating that as long as dietary cholesterol is not damaged by oxygen it has almost no ill effect on a person’s lipid profile. Both outside and inside our body, cholesterol is protected from oxygen damage by antioxidants such as vitamin C, vitamin E (including tocotrienol), and coenzyme Q-10. Although using vitamin E while cooking tends to be rather inconvenient, some people sprinkle vitamin C powder on eggs as they are cooking to protect the cholesterol.
Try the changes mentioned here, and do another lipid profile in six to eight weeks. Chances are you will see improvement.
This article appears in November 16 • 2001.