Dr. Alex Tan
We spoke with Dr. Alex Tan to get his advice about Lowering Cholesterol Naturally. Dr. Tan is a naturopathic medical doctor (ND) currently serving patients in the San Francisco Bay Area. He works as a primary care doctor at the Noe Valley Clinic, a progressive clinic where ND’s, MD’s and other health care providers come together to collaborate on patient care.
Why is it important to try to lower cholesterol if it is high and maintain healthy cholesterol levels?
Dr. Tan: The main reason to lower cholesterol is to decrease the risk of dying from a heart attack. Based on our biggest study to date (Lancet 2007), if you lower cholesterol even by about 4 mg/dL at age 40-49, you reduce the risk of a fatal heart attack by half; at age 50-69, by a third; and at age 70-89, by a sixth. This applies to both men and women. Small improvements can create a big impact. This is quite significant considering that heart disease is one of the leading causes of death in the U.S. The generic guideline is to lower total cholesterol to less than 200 mg/dL — preferably with low LDL (also known as “bad cholesterol") and high HDL ( “good cholesterol"). If you want more specific guidelines or want to figure out which factors affect your personal risk of heart attack, use a Framingham Risk Calculator.
Even though managing cholesterol is important, we should still put it in perspective. For example, not smoking, maintaining your ideal weight, exercising, eating a good diet, and managing stress have a huge impact on health. Cholesterol is one factor out of many — and interestingly enough, if you address your weight, exercise more and eat well, you have an excellent chance at improving your cholesterol level. They are all related. The solution is not one thing, it is many things done consistently everyday.
Of course, not all methods of reducing cholesterol are the same — some are better than others — in my opinion.
What are some lifestyle changes one can make to try to lower cholesterol naturally?
Dr. Tan: There are so many to choose from: dietary changes, exercise, the use of certain foods and supplements all have some data to support their ability to improve cholesterol levels. Losing weight if you are overweight is also very important. Reducing the waist line to no more than 35 inches in women, and 40 inches in men is important. Some studies show that each of those elements by themselves can improve cholesterol and/or reduce the risk of heart disease; some studies show that combining those might work even better. The evidence is there, we just need to do it, and do it consistently. Of course, try to manage stress and do something light-hearted often too.
What diet changes can one make to help support a lower cholesterol level?
Dr. Tan: On a big-picture level, eat more natural, whole foods rather than processed foods; eat enough protein, lots of vegetables, complex carbohydrates and adequate amounts of healthy oils (which means no trans-fats, but more omega-3 fatty acids and monounsaturates like extra virgin olive oil). In terms of specifics, aim for at least 25 grams of fiber daily - through oatmeal, vegetables, whole grains and other fiber sources like psyllium husk. Try to have cold water fish like salmon (wild only) on a regular basis (studies say two servings a week). If this is not possible, a reputable source of fish oil or omega-3 fatty acids is highly recommended.
There are studies to support a Mediterranean diet which is generous with vegetables, fruits, beans, and whole grains, moderate amounts of fish, chicken, and low amounts of red meat, and olive oil as the main oil. Side note, extra virgin olive oil is high in polyphenols or plant pigments, which have been shown by themselves to improve cholesterol.
And as always, don’t overeat. If you’re overweight, eat less and choose foods that have more nutrients per gram, such as vegetables, instead of empty calories from sugar, soda or white bread.
It can take up to 6-12 months to see the effects of diet on cholesterol levels, so be patient, and be consistent. You will feel better on so many levels, it’s worth it.
Are there ways to increase HDL?
Dr. Tan: Most evidence supports the use of niacin to increase HDL - up to 35%. The beneficial effect is dose dependent. Niacin can cause flushing which people don’t like. In these cases, it makes sense to start at a low dose and slowly build up. If people end up taking large doses of niacin, it is important that they ask their doctor about checking for liver enzymes because liver injury is a potential side effect at high doses. There is evidence supporting the use of exercise, red wine, polyphenols in berries in increasing HDL too.
Are there supplements one can take to help lower cholesterol?
Dr. Tan: There are many. If you think most of your excess blood cholesterol is from the diet, plant sterols and/or stanols prevent the absorption of dietary cholesterol and have actually been given an FDA nod for their use in decreasing heart disease risk. Soluble fiber is good for this too. If most of your excess cholesterol is made by your body, B vitamins such as niacin and pantethine have evidence to support their use. There are other supplements such as guggulipids, artichoke extract and policosanol - but the evidence is mixed or they are hard to find or expensive, so I don’t mention them too often.
By the way, anyone taking statin drugs should take some Co-Q10 as well because statins can reduce the body’s natural Co-Q10 levels.
Alex Tan ND
To reach Dr. Tan via his blog, go to http://tanmedicine.blogspot.com.
Nature Made Cholestoff offers a source of natural plant stanols and sterols. Nature Made Cholestoff Complete combines pantethine with plant stanols and sterols.