Tougher federal guidelines for blood cholesterol levels could lead millions more Americans to take cholesterol-lowering statin drugs. But whether your cholesterol is already too high or you just want to keep it from rising, experts say food and fitness remain key allies in defending against heart disease and stroke.
That message tends to get lost in the praise for statins. While their ability to lower cholesterol is impressive, what many consumers overlook is that statins are meant to be used along with a healthy diet and more physical activity.
There's no question that just making diet changes compared with taking statins to control blood cholesterol "looks like David versus Goliath," said Neil Stone, professor of cardiology at Northwestern University School of Medicine in Chicago and a member of the committee that wrote the cholesterol guidelines published last week.
When they're first prescribed, statins can lower blood cholesterol levels by 25 to 45 percent. That's four to eight times better than diet and lifestyle changes. So an increasingly common tactic is to simply prescribe higher doses of statins to control blood cholesterol, since popping a pill is often easier than changing diet or getting more physical activity.
Yet what most people don't realize, Stone said, is that the benefits of taking statins don't multiply at the same rate when doses are cranked up. "Every time you double the dose of statins, you only get an extra 6 to 8 percent lowering of cholesterol," he said. Higher doses cost more and have more possible complications.
By comparison, eating a healthy diet, low in fat and cholesterol, and getting more physical activity "also lowers blood cholesterol 6 to 8 percent," Stone said. "That saves you money and potential side effects...Plus, if you don't follow as good a diet as possible, you could diminish the effectiveness of statins such that you don't reach the newer blood cholesterol goals."
And what about those whose blood cholesterol levels are normal? The best bet, Stone and other experts said, is to do something that will sound familiar to Lean Plate Club members: Use healthy foods and regular physical activity as a defense against future blood cholesterol problems.
Here are some of the tactics that experts say can help lower blood cholesterol or just help maintain normal blood cholesterol:
* Aim for a healthier weight. Losing even a few pounds if you're overweight is one of the most powerful ways to reduce blood cholesterol levels. "People can lose just eight to 10 pounds and have a dramatic improvement in their blood pressure and blood cholesterol levels, even if they don't reach their target weight, even if they still need to lose 80 pounds more," said Judith Hsia, director of the Lipids Research Clinic at George Washington University. And as Hsia noted, "it doesn't cost money to eat less."
* Limit unhealthy fat. That means saturated fat, trans fatty acids and cholesterol found in marbled meat, poultry with the skin, fried food, full-fat dairy products and commercially prepared baked goods. Federal guidelines say to keep saturated fat at 10 percent or less of total calories; 7 percent or less for people with elevated blood cholesterol. The National Academy of Sciences has advised keeping trans fat as low as possible, while current advice for cholesterol from the American Heart Association is to limit it to 300 milligrams per day -- about that found in one egg yolk.
* Make yourself fit. As Stein notes, study after study shows that regular physical activity "has a very important part to play" in maintaining healthy blood cholesterol levels. "Eating well is part of it, but if you don't work hard to keep caloric consumption in check, you're going to get heavier." Physical activity burns calories. "And fitness is especially important to maintain weight that has been lost," he said.
* Fill up on fruit, vegetables and fiber. Fruit and vegetables are high in flavor, low in calories and loaded with fiber, which helps control weight and blood cholesterol levels. Don't forget to count oatmeal and other whole grains in that high fiber mix. The Food and Drug Administration (FDA) allows oatmeal makers to claim that it helps lower blood cholesterol levels when combined with a low-fat, low-cholesterol diet.
* Chew some healthy fat. Olive, canola, sunflower and other oils with mono-saturated or polyunsaturated fat help improve blood cholesterol levels. While they work in different ways, some can help lower low-density lipoprotein (LDL), the most damaging form of cholesterol, while others either boost or keep steady levels of the protective high-density lipoprotein (HDL).
* Spread some sterols or stanols on your toast. Research shows that these spreads -- sold as Benecol and Take Control -- help lower blood cholesterol levels by as much as 6 percent. Trouble is, they also contain as many calories as margarine. So go easy in slathering them on your morning bagel. "We don't want people to eat three bagels to get their servings of plant stanols or sterols," said Hsia, who advises patients using these products to have them just once a day.
* Nuts to you. Rich in healthy mono-unsaturated fat as well as omega-3 and omega-6 fatty acids (which can help avert a dangerous, irregular heartbeat), nuts are "a terrific way to supplement your diet," Stein said. But since they're also calorie-dense, a few go a long way. Sprinkle diced, sliced or slivered nuts on your salad or your morning cereal. But mete out whole nuts carefully rather than eating them mindlessly (at about 170 calories per handful).
* Add a little garlic. Not only is it filled with flavor, but there's some evidence that garlic may help lower blood cholesterol. Forget garlic supplements, Stein advised, since the data on them are still limited.
* Drink tea. In addition to other healthy substances, a soothing brew of either black or green tea contains antioxidants, which may help reduce inflammation linked with blockages in arteries.
* Savor soy. The FDA says that eating soy, in conjunction with a low-fat, low-cholesterol diet, may help lower risk of heart disease. Aim for 25 grams per day -- about the amount found in a handful of soy nuts and a glass of soy milk. For best effects, research suggests that soy must be eaten regularly.
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