How to Lower Your LDL Cholesterol

**Michael Greger** (0:00)
Doesn't it seem like when it comes to nutrition there are more opinions than facts to go around? Every day we hear new theories about diets and supplements and the best foods to eat. Well, my role is to take the mystery out of good nutrition and look at the science. Welcome to the Nutrition Facts Podcast. I'm your host, Dr. Michael Greger.
Today we take a deep dive on lowering cholesterol, LDL cholesterol, through diet, which was churned down to a book that came out last October, I believe. And we start with a story from our former senior research scientist, Dr. Christine Dennis.

**Christine Dennis** (0:41)
Of the top 10 take-home messages for the primary prevention of cardiovascular disease, take-home number 9 is that cholesterol-lowering statin drugs are considered the first-choice drug treatment for preventing heart disease in those with sufficiently elevated LDL cholesterol.
Those side effects, like muscle pain or weakness, may impact up to a quarter of users. Regardless, whether you and your doctor decide to start drugs, the number one take-home message is that the most important way to prevent heart disease, the number one killer of men and women, is to promote a healthy lifestyle throughout life. Enter the portfolio diet for the maximal reduction of LDL cholesterol. There are three main added factors in our diet that raise LDL cholesterol. Trans fat, saturated fat, and dietary cholesterol. Therefore, the tolerable upper intake levels of these three factors are essentially zero, since any intake above zero increases LDL cholesterol concentration and therefore increases risk of coronary heart disease. So trans fat, saturated fat, and cholesterol intake should be as low as possible. That means cutting back as much as possible on meat, dairy, eggs, and junk. And since partially hydrogenated oils must be removed from the US food supply by law, all these other uses have been banned. So animal products are now the leading source of trans fat in the US diet as well. Those eating a Western diet have circulating LDL levels around 120 milligrams per deciliter. No surprise then that those eating plant-based tend to have lower LDL, with lower levels the longer they have been eating a whole foods plant-based diet, as low as 70 But even though that's an excellent number compared to most people, there really isn't a safe cutoff when it comes to LDL, the lower, the longer, the better, even if you're at low risk. That's where the portfolio diet can come in. By eating a healthy plant-based diet, you've already subtracted all the major foods that increase your cholesterol. The portfolio diet is a plant-based diet with a bonus, a portfolio of foods. Four food types you can add to your diet to pull cholesterol out of your system. The food components include one and a half ounces of nuts a day, good sources of plant protein, in other words, legumes like soy, other beans, split peas, chickpeas, or lentils, lots of food with viscous fiber. That's the kind of slimy fiber found in oats, okra, eggplant, barley, and gram flaxseeds. Finally, two grams a day of plant sterols from fortified foods or supplements. Dr. Greger is going to take a deep dive into fiber sterols. But first, let's just see what this diet can do. The portfolio diet was tested head to head against statin treatment plus a very low saturated fat diet in a four-week randomized controlled trial among people with high cholesterol. And incredibly, those in the portfolio diet group had nearly a 30 percent drop in LDL cholesterol, similar to the 33 percent drop observed in the statins plus low saturated fat group.
Simply by emphasizing the addition of four dietary components that are each likely to contribute four to seven percent to overall cholesterol reduction, you have a diet that reduces LDL cholesterol with drug-like potency. In a systematic review and meta-analysis of controlled trials of the portfolio diet, we still see consistent LDL lowering benefits, about a 17 percent drop above and beyond the currently recommended, relatively strict National Cholesterol Education Program, step two diet, along with lowering of systemic inflammation and an estimated 13 percent decrease in 10-year heart disease risk.
These results weren't even in individuals who all actually went on a portfolio diet. They were merely told to eat that way. Even just two educational sessions over six months telling people to adopt it, can have a significant effect. I mentioned the four food components, but what does a sample menu look like? Nuts for snacks, soy foods and beans for plant protein, oats, barley, okra, eggplant, metamucil and oranges for soluble fiber. They were using plant sterile fortified margarine, like Benacol and Promise Active, formerly known as Take Control.
Yes, they have added plant steriles, but they're also chock full of salt, saturated fat and artificial flavors.