How I Conquered High Cholesterol Through Diet and Exercise

He dismissed my questions about lifestyle and reversal. Further research led me to Dr. McDougall, and registered dietitian Jeff Novick. All these people gave hope for arresting, and perhaps reversing, my condition through diet and lifestyle modifications. In contrast, neither my internist, nor my cardiologist, was aware of these doctors or their programs or any significant benefit to lifestyle modification.

My early results were promising. My internist was astounded. Medication had only lowered my numbers slightly. I was on Dr. I found that everything I needed was available immediately and for free through Dr. I learned that my results would directly reflect my compliance with the program. I resolved that I would do this program percent.

I still plan on going. I owed that to myself and my family. Almost immediately, my chest pain went away. My internist asked how I had accomplished this and my dramatic cholesterol drop, and then became quite interested in my program. I needed his help because of the side effects of the medications that occurred once I changed my diet.

I had to quickly get off my blood pressure medications because my readings were extremely low and I was feeling light headed. My blood sugars came way down and I had to terminate my diabetes medication. I have lost over 60 pounds since beginning my new diet and exercise program in January of , and I continue to lose as my energy increases. I have had no more kidney stones. After following my progress for almost a year and a half, the cardiologist wanted to repeat the nuclear heart scan.

He was also sure that I was wrong when I had told him that many clinical trials have shown no important benefits other than pain relief for the surgery they had proposed for me more than a year and a half ago. Despite my many obvious improvements, the cardiologist still believed that coronary artery disease is always progressive, and told me not to get my hopes up about the new test. I repeated the exercise nuclear heart scan on May 5, This time, I felt great running on the treadmill. I took my heart rate beyond the maximum expected for my age, and had no pain.

The monitors I was connected to indicated no problems. Immediately after the test, I spoke with my cardiologist, who seemed somewhat perplexed. He chose his words very carefully. He wanted to know if I had felt chest pain on the first exam in I think he did not believe the previous test results, because this time my heart showed only a single mild abnormality. Most noticeable was that the large area of obstruction found on my first test was not seen at all.

He seemed to not want to confront the possibility that the both tests were accurate—that I had actually reversed my serious condition with a simple change in diet and a little exercise. How could he question the obvious: Right before his eyes I went from sick and symptomatic to feeling and looking great. His skepticism continued as he explained to me that despite the fact that the occlusion could no longer be seen, it did not mean that I was totally cured. But at least he now accepted my decision to avoid surgery as responsible. He was able to exercise almost 10 minutes on the standard Bruce protocol.

There were no reported symptoms consistent with angina pectoris. He denied chest pain or chest discomfort. He denies any symptoms of congestive heart failure—shortness of breath and extreme fatigue. The myocardial perfusion images showed there was still a subtle inferior wall perfusion defect…[that is it]. I look back on this lifestyle change as one of the most significant things I have ever done. So many everyday problems have vanished — high blood pressure, diabetes, high lipids, indigestion, obesity, kidney stones, etc. More important, this is a treatment that I can feel and see.

Before, those pills and my old diet made me look and feel awful. I now have a new lease on life. I am proud to be a Star McDougaller because I can share and help others. I would like everyone to have the same chance for health and happiness I have. That is all it takes—it is so simple. Although it was not easy at first, I cannot imagine anyone who tried this program for 30 days, who would not decide that it is a far better way to eat and live than what is commonly called the Standard American Diet.

As a footnote, my internist recently referred a colleague of his, a surgeon, to me. The surgeon had similar problems to my own, and I invited him and his pathologist wife to dinner and a movie consisting of Dr. I recently received an email that he has dropped over points off his cholesterol and LDL, and over points off his fasting blood sugar, and is feeling great.

The intention of this research was to show that the early treatment of people with diabetes with heart surgery angioplasty with stents or bypass would result in a better chance of survival than from no surgery.

The results were no benefit from surgery. While genetics can certainly make someone more prone to inflammatory problems, lifestyle factors also have a major role. From a dietary standpoint, trans fats and refined sugars ramp up inflammation much faster than foods that contain cholesterol.

Trans fats are damaged fats that occur as a result of overprocessing foods, and are not the heart-healthy fats that are found in nature. So how do you know if inflammation is your problem? These two tests should be considered alongside the standard cholesterol and triglycerides measurements to determine actual heart disease or chronic disease risk: C-reactive protein test Homocysteine test C-reactive protein measures specific inflammatory markers in the body that can help to determine inflammation levels as well as the potential for narrowing of arteries.

While everyone needs a certain amount of homocysteine in their blood, elevated levels can be indicative of inflammation and can be irritating for blood vessels, leading to arterial hardening and risk for heart attack. To offset this genetic mutation, it is recommended that we limit processed foods and eat a diet rich in high-quality animal products and green vegetables. Omega-6 fatty acids, commonly found in nuts and seeds , are more pro-inflammatory, but are often eaten in far greater amounts than omega-3s.

Eating omega-3s on a daily basis and limiting intake of omega-6 fatty acids can help to restore balance to this fat ratio, leading to decreased inflammation and improved heart health. Skip Trans Fats, Refined Sugars, and Processed Foods Trans fats, refined sugars and processed foods can be especially harmful if you have existing inflammatory conditions, known MTHFR mutations, or a family history of heart disease. Not only do these foods lead to inflammation, they can also wreak havoc on the digestive system as well as contribute to weight problems and hormone imbalance.

While there is no one-size-fits-all approach to achieving perfect sleep and reduced stress levels, certain habits can contribute to healthy balance: Regular exercise A bedtime routine Reduced smartphone and computer use at night Decreased intake of caffeine, alcohol , and other stimulants Healthy stress outlets, like therapy or meditation Read This Next: She ate her way back to health using a Paleo diet, lost 80 pounds, and had a healthy baby after numerous miscarriages.

She focuses on simple nutrition practices that promote long-lasting results. For more posts by Aimee, click here. At short term 6 or 12 months , nutrition therapy compared with dietary advice was associated with a 0. Modification of plasma lipid profile by low-fat dietary interventions was dependent on menopausal status of women. In contrast, in a strict environment, such as metabolic ward studies dietary changes can induce a greater reduction in cholesterol concentrations. Similar efficacy was observed in six of the seven trials of diet for secondary prevention.

The effectiveness of dietary therapy was enhanced when individualized counseling was used, follow-up was maintained, and weight reduction was achieved. Responses of blood lipids and lipoproteins to individual SFA intake are heterogeneous. Cholesterol-raising effects of SFA depend on chain-length as these effects decrease as chain lengths increase. Overall effects of dietary cholesterol on blood cholesterol level are limited and modulated by other nutritional components.

Founded on early observations on the relationship between occupational physical activity PA and chronic disease risk e. They found that the sedentary bus drivers had higher rates of CVD mortality than their active counterparts, the conductors, and postulated that physically active work had a cardioprotective effect.

This work was extended to postmen and postal clerks, where postmen who walked or cycled while delivering mail had much lower rates of heart disease than the postal clerks who had sedentary jobs Further, Morris et al. Around the same time, in , Ralph Paffenbarger et al. They found that the CVD death rate was significantly lower in the most active compared with sedentary workers. In , Paffenbarger et al.

Numerous other studies have documented an inverse association between occupational PA and CVD risk In , to test the hypothesis that PA outside the occupational domain would provide cardioprotective benefits, Morris et al. Another study of Morris et al. A low PA when combined with another risk factor i. Over the past few decades, there has been a substantial accrual of epidemiological evidence on the inverse relationship between leisure time PA and CVD. A recent meta-analysis of 26 prospective cohort studies , individuals and 20, CHD events with follow-ups of 4 to 25 years reported significant reductions in CVD mortality in both high and moderate levels of self-reported leisure time PA Although being used in the literature interchangeably, PA and exercise denote different concepts.

Physical Activity PA appears to impact CVD risk through beneficial effects on several factors, including adiposity, insulin sensitivity, glycemic control, type 2 diabetes incidence, blood pressure, blood lipids, endothelial function, hemostasis, and inflammatory defense systems After multivariate adjustments i.

PA intervention was based on lifestyle consultations and subjects on lipid-lowering medications were excluded from analysis. A 5-year follow up study by the same investigators demonstrated significant improvements in TC, LDL-C, and TG among 4, participants aged 30—60 years, with an additional significant improvement in HDL-C seen only in men In contrast, compared with the ref group, all-cause mortality risk was elevated in those who did not meet PA guidelines and whose HDL-C was either normal or low. CVD mortality hazard ratios were similar, although confidence intervals were wider.

A community intervention trial among Spanish adults mean age: At the end of the study, TC Compared to usual care, lifestyle interventions achieved significant improvements in TC Combined strategies had greater and significant effects on blood lipid profile than PA alone strategy. The authors noted that this finding may be related to methodological shortcomings in exercise-only interventions such as low adherence, insufficient exercise volume or length of intervention In addition, evidence suggests that it may take up to two years for a previously sedentary obese individual to attain enough volume of exercise to modify risk factors.

In addition, waist circumference and BMI were decreased. A recent small study among inactive older women with hypertriglyceridemia compared the effects of different patterns of walking on PP TG levels Aerobic exercise training AET includes cardiorespiratory endurance exercises such as jogging, running, and cycling In a wk shorter duration study of young women, LeMura et al. A review article examined the effects of AET on blood lipids in exercise training intervention trials of more than 12 wks The increase in HDL-C with AET was inversely associated with its baseline level, but there were no significant associations with age, sex, weekly volume of exercise, or with exercise-induced changes in body weight or peak oxygen effect VO 2max.

Men generally had a greater reduction in TG levels than women. It was concluded that moderate- to hard-intensity AET inconsistently results in an improvement in the blood lipid profile, but that the data was insufficient to establish dose-response relationships. In , while reviewing 51 studies on PA interventions, Kesaniemi et al.

It was concluded that the most likely PA-induced improvement in the lipid profile is an increase in HDL-C concentrations. This finding was supported by Banz et al. In this study, HDL-C was the only component of the lipid profile that improved by the intervention. A RCT by Kraus et al. It appears that the effects depend on the amount rather than the intensity of exercise training.

In line with these findings, Nybo et al. The authors suggested that the training volume, as opposed to the training intensity, is the key to improving the lipid profile, and that there may be a relationship between body fat which decreased only in the prolonged exercise group and cholesterol levels, whereby a volume sufficient to elicit changes in fat mass is required to favorably alter the lipid profile. While controlling the exercise volume equal energy expenditure, i. Significant improvements in blood lipid profile were reported in the high-intensity, but not in the moderate-intensity exercise group, with a significant decrease in TC, LDL-C and non-HDL-C concentrations.

These findings suggest that moderate-intensity exercise may be sufficient to increase HDL-C concentrations, but that a more intense exercise is needed to improve other components of the lipid profile, such as LDL-C or TG concentrations. The effects of exercise or PA on blood lipid profile may differ between gender groups. Specifically, HDL-C increased significantly more in men than in women , and men generally experienced greater reductions in TG concentrations than women However, underlying mechanisms of these gender-specific differences as well as overall mechanisms by which exercise exerts its effects on blood lipids have not been fully delineated.

The mechanisms may include reductions in hepatic lipase activity, increases in lipoprotein lipase activity and lecithin-cholesterol acyltransferase , as well as increases in peak LDL particle diameter and HDL 2 -mass , Among elderly women years , a wk AET intervention was associated with beneficial effects on blood lipid profile , suggesting that AET can help to ameliorate cardiometabolic burden also in this group. In a systematic review Tambalis et al. The authors concluded that AET programs result in favorable effects only for high-intensity programs, with the most frequent alteration being an increase in the HDL-C.

In elderly women years , who were active but non-exercising, a wk RT intervention increased HDL-C and decreased TG compared to baseline values Of note, body weight and diet were unchanged across groups. A study by Lira et al. The total exercise volume was equalized between the groups to ensure that the RT intensity was the factor being assessed. It was concluded that the acute RT may induce changes in lipid profile in a specific-intensity manner, and low and moderate exercise intensities appear to be promoting more benefits on lipid profile than high intensity RT.

The acute effects of RT sessions performed at different levels of high- three sets with max of 15 repetitions and low- one set with max of 15 repetitions volume RT on postprandial lipemia was investigated in postmenopausal women One RT session involved eight exercises. A recent study by Vatani et al. Interestingly, HDL-C concentration was found to be significantly increased only with the high-intensity regimen. Previous observations, however, have indicated that HDL-C is likely to be the first lipid profile response to PA and exercise, even at low intensities of activity Reductions in fat mass as well as a gain in lean body mass were predictors of TG reductions, whereas the use of lipid-lowering drugs was a predictor of TC and LDL-C reductions.

There is limited data on the effects of combined training modalities CT on blood lipid profile.

For CT protocols, the results were inconsistent: Two other trials reported no significant alterations on the lipid profile in relation to the control group , It appears that no additional LDL-C reduction resulted from combining the two modes of exercise. Reductions in TC, LDL-C and TG were observed in the exercising group but did not reach statistical significance when compared with values in the controls.

The authors suggested that the participants were too young to elicit the clinical and significant effects shown by previous research in predominantly elderly or middle-aged participants. Compared to RT, AET resulted in a significantly more pronounced reduction of body weight, waist circumference, and fat mass. RT was more effective than AET in improving lean body mass.

When comparing CT with RT, mean difference in change of body weight, waist circumference, and fat mass were all in favor of CT. There were no significant differences in blood lipid profile between modalities. It was concluded that the CT is the most efficacious means to reduce anthropometric outcomes and should be recommended in the prevention and treatment of overweight, and obesity whenever possible. A comprehensive review by Mann et al.

The authors confirm the beneficial effects of regular activity on cholesterol levels, and present evidence-based exercise recommendations aimed at facilitating the prescription and delivery of interventions for optimizing cholesterol levels. Many population-based and cross-sectional studies have failed to detect an association between Lp a and PA level However, in a large multicenter study of Finnish children and young adults, PA was inversely correlated with Lp a concentration in a dose-dependent manner Consistent with these findings, an inverse association between physical fitness and Lp a concentration was seen in young children and adolescents with diabetes mellitus Furthermore, prolonged high-intensity exercise training may impact Lp a levels as experienced distance runners and body builders have been shown to have higher Lp a levels , However, intervention studies extending from a few weeks to four years have not reported any changes in median Lp a concentration in response to moderate exercise training, despite improvements in fitness and other plasma lipoprotein concentrations , Overall, the magnitude of exercise-induced changes in Lp a levels are modest and any impact related to specific apo a size isoforms has not been addressed.

The PAG recommendations complement the Dietary Guidelines for Americans as well as other national health promotion and disease prevention efforts. Aerobic activity should be performed in episodes of at least 10 minutes, and preferably spread throughout the week. WHO developed the "Global Recommendations on Physical Activity for Health" with the overall aim of providing national and regional level policy makers with guidance on the dose-response relationship between the frequency, duration, intensity, type and total amount of PA needed for the prevention of non-communicable diseases.

PA includes leisure time PA e. For adults aged 18—64 years, it is recommended doing at least min of moderate-intensity aerobic PA throughout the week, or doing at least 75 min of vigorous-intensity aerobic PA throughout the week, or an equivalent combination of moderate- and vigorous-intensity activity. Aerobic activity should be performed in bouts of at least 10 minutes duration.

Examples of current recommendations on PA and exercise are shown in Table 3. PA impacts cardiovascular risk through beneficial effects on several factors, including blood lipids and lipoproteins. AET has variable effects on blood lipids with the most common change being an increase in HDL-C level a mean increase of 4. AET volume, as opposed to intensity, maybe the key to improving the lipid profile.

Acute RT-induced changes in lipid profile maybe depend on intensity as regimens with a low or moderate intensity appeared to promote more benefits than high intensity RT. There are no significant differences in blood lipid profile between CT and RT modalities. Functional food is a term that is used by different groups to describe food with potential health benefits. There is no universally accepted definition for a functional food. Oatmeal is an example of a functional food because it helps to lower cholesterol levels in addition to providing energy and nutrition. Functional foods have been suggested to have the potential to reduce the risks associated with a number of diseases such as hyperlipidemia, CVD, diabetes, hypertension, bone disorders, immunological diseases, digestive disorders, and cancer , , The use of functional foods has been increasing over the past two decades due to the increased interest in their potential health benefits Although there is no universally accepted definition of functional foods, several definitions have been proposed.

FOSHU refers to "foods containing ingredients with functions for health and officially approved to claim its physiological effects on the human body", and is intended to be consumed for the maintenance or promotion of health or special health uses by people who wish to control health conditions, including blood pressure or blood cholesterol In addition to the Japan Ministry of Health, Labor and Welfare, other organizations have offered definitions of functional food. The Academy of Nutrition and Dietetics defined functional foods as "whole foods along with fortified, enriched, or enhanced foods that have a potentially beneficial effect on health when consumed as part of a varied diet on a regular basis at effective levels" The European Commission Concerted Action on Functional Food Science considers foods to be functional if they have a beneficial effect on one or more functions of the body and are still in the form of food, not a dietary supplement No legal definition exists for functional foods in the United States, and there are no special regulations.

Under these regulations, functional foods can be placed into a number of existing regulatory categories such as conventional foods, food additives, dietary supplements, medical foods or foods for special dietary use. Beyond basic nutrients such as carbohydrates, proteins and fats, functional foods generally contain bio-active components that may provide health benefits. There are many potential bioactive components including dietary fiber, polyunsaturated fats e.

The commonly accepted characteristics of functional foods are: Dietary supplements are not considered functional foods as they are products in non-food form intended to supplement the diet. Functional foods could be classified based on 1 nature of origin, 2 degree of processing whole foods, processed foods, conventional foods with enhanced bioactivity , and 3 health benefits.

Functional foods based on their origin can be classified into two groups: Widely used functional foods from animal origin are fish, fish products such fish oil, fortified eggs and milk products. Functional foods from plant origin include fruits, vegetables, nuts, seeds, fiber, whole grains, and spices. Functional foods based on processing could be categorized into three groups: Whole foods are unprocessed and unrefined, or processed and refined as little as possible before being consumed. They naturally contain bioactive components and have not been fortified. Whole foods of plant origin include fruits and vegetables, nuts and seeds, beans and legumes, whole grains and fiber.

Whole foods of animal origin include fish or dairy products. Processed functional foods do not generally contain natural bioactive components and these are added. Examples of processed functional foods include margarine spreads that contain n-3 fatty acids, calcium-fortified orange juice, and folic acid enriched breads.

Conventional foods with enhanced bioactivity are foods that naturally contain bioactive components but where the level has been modified or concentrated. Examples of conventional foods with enhanced bioactivity include yogurt with increased level of probiotics, tomatoes with increased levels of lycopene, and eggs with increased levels of n-3 fatty acids. Clinical research studies conducted on functional foods over the past two decades have indicated that some functional foods may be useful in preventing, reducing and or treating risks associated with lipid disorders, CVD, diabetes, obesity or hypertension , , , In addition, we have examined the safety issues, and adverse effects of these functional foods.

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Clinical research studies conducted in the s to early s implicated differential effects of various types of fats on cardiovascular outcomes. These studies suggested that many saturated fatty acids e. In contrast, it was observed that there could be health benefits from the consumption of fish e. Several studies have suggested that these beneficial effects may be due to the presence of PUFAs e. The market for fish and fish products has grown significantly in recent years because of the potential health benefits associated with fish consumption Fish, especially salmon, mackerel, tuna, sturgeon, mullet, bluefish, anchovy, sardines, herring, trout, and menhaden are very rich sources of n-3 fatty acids, and contain relatively lower amounts of saturated fats.

The amount of n-3 fatty acids and n-6 fatty acids in fish can vary significantly depending on a number of factors such as the type of fish, location of the catch, fish diet, and season While many have recommended the intake of fish with a larger ratio of n-3 to n-6 fatty acids, the long-term effects of intake of fish with greater n-3 to n-6 ratio is not fully understood. Fish such as salmon, mackerel, tuna, and herring can contain about 1, mg of n-3 fatty acids in about g of fish.

Two main n-3 fatty acids are found in fish and other sea products, eicosapentaenoic acid EPA, The body is capable of converting ALA into EPA and DHA but the conversion rates are low and influenced by several factors such as smoking, environmental toxins, aging, excessive saturated fat intake, alcohol, and certain medications The preparation of fish has the potential to impact on health benefits, as many methods appear to alter n-3 fatty acid content.

Baking and frying tend to result in breakup of the existing chemical bonds and frying can lead to the greatest losses in n-3 fatty acid content. Consumption of fish and fish products has been initially reported to provide several health benefits, including lowering of TG, reducing the risk of CVD, modest lowering of blood pressure, and lowering the risk of stroke , Reports of a TG lowering effect from n-3 fatty acids from fish and fish oil go back more than 50 years , Subsequently several studies observational, interventional and meta-analysis were undertaken to ascertain these findings The major findings of these studies are: A recent meta-analysis of 47 studies demonstrated that an average daily intake of 3.

In dyslipidemic and diabetic patients, apoB and LDL-C levels showed a divergent pattern, with no change or a slight decrease in apoB levels and a significant increase in LDL-C Fish oil appears to have influences on LDL particle size, particularly the number of small, dense LDL particles , , likely associated with reductions in TG.

Eicosapentaenoic acid ethyl ester can not only lower TG but also lower total and small LDL particles In mouse studies, HDL-C increased after consumption of fish oil compared to sunflower oil for 16 weeks In some human studies, only a small increase in HDL-C as a result of n-3 fatty acid intake has been noted , This meta-analysis also did not show an effect on LDL-C.

There are two fish oil supplements e. A large body of experimental, clinical, and epidemiologic research has explored potential benefits of EPA- and DHA-rich fish oil on cardiovascular health , , , , Several randomized clinical trials have examined the effects of fish oil supplementation on nonfatal myocardial infarction, ischemic stroke, atrial fibrillation, recurrent ventricular arrhythmias, and heart failure, but results have been inconsistent , In the Norfolk-based European Prospective Investigation into Cancer cohort, the use of omega-3 polyunsaturated fatty acid n-3 PUFA supplements utilized mainly cod liver oil was associated with a lower hazard of CHD mortality in a population with low fish consumption over a 19 year period The AHA has provided a recommendation to consider use of fish oil supplementation in subjects with a recent myocardial infarction or heart attack There is uncertainty regarding the benefit from use of omega-3 supplementation in established CVD.

OM3 clinical trials did not find such benefits. To date, there is no conclusive evidence to recommend fish oil supplementation for primary or secondary prevention of CVD A meta-analysis of 10 trials involving 77, individuals reported that omega-3 fatty acid supplementation had no significant association with coronary heart disease death, nonfatal myocardial infarction, nonfatal coronary heart disease or any major vascular events There are some safety concerns when fish oil is consumed in high doses as an intake of more than 3 g per day might impact blood clotting and increase the chance of bleeding Other side effects from intake of fish oil can include bad breath, heartburn, nausea, loose stools, rash, and nosebleeds.

Using fish oil together with antihypertensive drugs may result in a small but statistically significant reduction in blood pressure While some fish such as swordfish, king mackerel, tilefish, and albacore tuna may carry a higher risk of mercury poisoning, fish oil has not been found to carry a significant risk. The AHA recommends consumption of two servings of fatty fish per week e.

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Higher dosages of n-3 fatty acids are required to reduce elevated TG levels g per day and to reduce morning stiffness and joint pain in patients with rheumatoid arthritis at least 3 g per day. Modest decreases in blood pressure occur with significantly higher dosages of n-3 fatty acids. The Dietary Guidelines for Americans recommend consuming at least 8 ounces of seafood per week to reach an average daily intake of mg per day for a total of 1, mg of EPA and DHA per week Nuts and seeds are functional foods of plant origin.

The energy content of nuts and seeds is mainly derived from fat and protein, while the carbohydrate content is less compared to beans and legumes. Consumption of nuts in moderate amounts has been found to provide health benefits such as reducing cholesterol levels and lowering CHD risk Limited evidence also exists for beneficial effects on hypertension, cancer, and inflammation.

The most consumed edible tree nuts are almonds, hazelnuts, walnuts, pistachios, pine nuts, cashews, pecans, macadamias and Brazil nuts.

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Peanuts are botanically groundnuts or legumes, and are widely considered to be part of the nuts food group. Nuts are generally consumed as snacks fresh or roasted , in spreads peanut butter, almond paste , or as oils or baked goods. Seeds come in all different sizes, shapes and colors. Popular seeds include flax seeds, pumpkin seeds, sunflower seeds, chia seeds, sesame seeds and mustard seeds. They also contain small amounts of saturated fat. For other nuts e.

Phytochemicals present in nuts include carotenoids, phenols and phytosterols. The beneficial effects of nuts and seeds are likely due to the presence of unsaturated fats, fiber, antioxidants, and phytochemicals , The fatty acid profile and fat content of nuts is suggested to be responsible for observed health benefits, particularly the lipid altering effects, associated with the consumption of nuts and seeds Antioxidants and phytochemicals present in nuts and seeds may also contribute to cardioprotective properties and cholesterol lowering The individual contribution of each of these bioactive components is not yet fully known, and further studies are needed to understand their mechanism of action.

In the past 25 years, a number of studies have been carried out on the potential health effects of nuts and seeds, including feeding trials to investigate the effect of nut consumption on blood lipids and other biological indexes of heart disease , Walnuts and almonds are among the most studied nuts. Fewer studies have been conducted on peanuts, pecans, macadamia nuts, hazelnuts, and pistachios. To date, there is even less experience with Brazil nuts, cashews, or pine nuts. Health benefits of seeds, including flax seeds and chia seeds have generally attracted fewer studies. It was also noted that consumption of nuts and seeds was beneficial in reducing CVD , Health benefits of nuts and seeds vary significantly depending on the type and nutrient composition and quantity consumed.

There are several trials that show reductions in cholesterol and TG with the consumption of walnuts. In another trial, the effect of walnut oil consumption on lipid profiles in individuals with T2DM was examined and it also showed a reduction of TC A meta-analysis on the effect of walnuts on lipid levels that included participants showed a decrease in TC and LDL-C In another meta-analysis that analyzed 1, participants with walnut enriched diets, blood lipids were lowered: Some have suggested that walnut consumption may alter the composition and function of the human gastrointestinal microbiota, including firmicutes species e.

This may contribute to alterations in urolithins and secondary bile acids that could contribute to alterations in cholesterol sub fractions , Cholesterol-lowering effects have also been observed with consumption of almonds, hazel nuts, pistachios, and peanuts. Subjects who intake a mixture of nuts appear to have reductions in LDL-C in many studies. As in other studies, it was also noted that the cholesterol lowering effect was dose dependent, and that dose-related effects were observed in both men and women.

In addition, an inverse association between cholesterol responses and BMI was seen during consumption of large quantities of nuts. The addition of nuts to a Mediterranean diet may render the LDL-C particles to be less atherogenic Other studies have noted that the estimated cholesterol lowering effect of nuts was greater in individuals with higher initial values of LDL-C and in those with a lower baseline BMI However, not all studies noted reductions in LDL-C with intake of a nut mixture. The effect of flaxseed has also been investigated.

In a study with milled flaxseed, LDL-C reduction was seen in patients with PAD, who were on cholesterol lowering medications, by about 0. While intake of flaxseed may alter LDL-C, it does not appear to significantly shift the fecal metabolome The cholesterol-lowering effects were more apparent in individuals with elevated baseline cholesterol concentrations. There are two major concerns associated with nut consumption, a possible weight gain , and allergic reactions There is considerable evidence indicating that there are no adverse effects of nut consumption in moderate quantities on energy balance or body weight 65 , Allergic reactions to nuts are due to allergenic seed storage proteins that elicit specific IgE antibodies.

An additional concern is potential toxicity through contamination of nuts with mycotoxins, particularly aflatoxins. Flaxseed is likely safe for most adults although adding flaxseed to the diet might increase the number of bowel movements and might also cause gastrointestinal side effects such as bloating, gas, abdominal pain, constipation, diarrhea and nausea.

Higher doses are likely to cause more such side effects. The Dietary Guidelines for Americans state that nuts and seeds can be a good source of protein and monounsaturated and polyunsaturated fats The Dietary Guidelines for Americans recognizes that eating some type of nuts e. Raw or dry-roasted nuts rather than those cooked in oil are recommended.

Fiber is defined as the edible carbohydrate portion of plants resistant to enzymatic digestion e. Fiber is found mostly in fruits, vegetables, whole grains, nuts, seeds, psyllium seeds, beans and legumes.

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Fiber is known for its ability to provide bulk to stool and prevent or relieve constipation. In addition, fiber provides several other significant health benefits including lowering blood cholesterol concentrations by interfering with cholesterol absorption and reabsorption of bile acids , They may also slow the absorption of sugar and help improve blood glucose levels , , , aid in weight loss , and reduce obesity Fibers are generally classified into two types: They are present in all types of peas and beans like lentils, split peas, guar beans, pinto beans, black beans, kidney beans, garbanzo beans and lima beans, as well as in oats, barley, and some fruits and vegetables like apples, oranges and carrots.

Fiber from psyllium seed, an ingredient in some over-the-counter laxatives, is also part of this group. The skins of fruits and vegetables are good sources of insoluble fiber. Wheat dextrin wheat bran is another good source of insoluble fiber, and is added to many dry breakfast cereals. Most foods contain both types of fibers.

Insoluble fibers have a laxative effect but have a lower hypolipidemic response compared with soluble fibers. A summary of the fiber content of some foods is given in Tables 8. Adapted from Anderson JW. Plant Fiber in Foods. The mechanism of action of fibers is not fully understood. Initially, the observed cholesterol-lowering benefits were ascribed to solubility effects and binding of bile acids with subsequent fecal elimination , requiring an enhanced formation of bile acids from cholesterol. Soluble fibers slow the digestive process which could result in a slow uptake of sugars. Recent studies have indicated that other fiber properties such as formation of gels and extent of fermentation ability might also contribute to the observed physiological effects of the fibers The formation of gels slows gastric emptying, and contributes to levels of satiety.

Soluble fiber and resistant starch molecules can be fermented by bacteria in the large intestine to produce short chain fatty acids, which may impact circulating cholesterol levels and hepatic cholesterol synthesis Potential health benefits of fibers include a tendency to lower cholesterol and blood glucose levels , contributing to weight loss and obesity reduction, as well as lowering blood pressure These actions may translate to reducing the risk of development or slow the progress of several diseases such as CVD , diabetes , stroke , hypertension , and gastrointestinal disorders Public awareness of the health benefits of dietary fibers has increased over the past two decades; supermarkets now generally list the content of dietary fiber in most food labels.

A meta-analysis of 26 RCTS with diets rich in fiber e. The extent of LDL-C lowering depends on the fiber type, quantity and frequency of consumption. A mean reduction in LDL-C concentrations of 0. A meta-analysis, including 67 controlled trials was conducted to determine the cholesterol-lowering effects of dietary fibers The major findings were that consumption of soluble fibers e. IT Study, it was not clearly explained by fiber intake