Cholesterol: Top 5 foods to lower your numbers Diet can play an important role in lowering your cholesterol.

Here are five foods that can lower your cholesterol and protect your heart. By Mayo Clinic staff Can a bowl of oatmeal help lower your cholesterol? How about a handful of walnuts or even a baked potato topped with some heart-healthy margarine? A few simple tweaks to your diet like these, along with exercise and other heart-healthy habits may be helpful in lowering your cholesterol. 1. Oatmeal, oat bran and high-fiber foods Oatmeal contains soluble fiber, which reduces your low-density lipoprotein (LDL), the "bad," cholesterol. Soluble fiber is also found in such foods as kidney beans, apples, pears, barley and prunes. Soluble fiber can reduce the absorption of cholesterol into your bloodstream. Five to 10 grams or more of soluble fiber a day decreases your total and LDL cholesterol. Eating 1 1/2 cups of cooked oatmeal provides 6 grams of fiber. If you add fruit, such as bananas, you'll add about 4 more grams of fiber. To mix it up a little, try steel-cut oatmeal or cold cereal made with oatmeal or oat bran. 2. Fish and omega-3 fatty acids Eating fatty fish can be heart healthy because of its high levels of omega-3 fatty acids, which can reduce your blood pressure and risk of developing blood clots. In people who have already had heart attacks, fish oil or omega-3 fatty acids reduces the risk of sudden death. The American Heart Association recommends eating at least two servings of fish a week. The highest levels of omega-3 fatty acids are in:

Mackerel Lake trout Herring Sardines Albacore tuna Salmon Halibut

You should bake or grill the fish to avoid adding unhealthy fats. If you don't like fish, you can also get small amounts of omega-3 fatty acids from foods like ground flaxseed or canola oil.

You can take an omega-3 or fish oil supplement to get some of the benefits, but you won't get other nutrients in fish, such as selenium. If you decide to take a supplement, just remember to watch your diet and eat lean meat or vegetables in place of fish. 3. Walnuts, almonds and other nuts Walnuts, almonds and other nuts can reduce blood cholesterol. Rich in polyunsaturated fatty acids, walnuts also help keep blood vessels healthy. Eating about a handful (1.5 ounces, or 42.5 grams) a day of most nuts, such as almonds, hazelnuts, peanuts, pecans, some pine nuts, pistachio nuts and walnuts, may reduce your risk of heart disease. Just make sure the nuts you eat aren't salted or coated with sugar. All nuts are high in calories, so a handful will do. To avoid eating too many nuts and gaining weight, replace foods high in saturated fat with nuts. For example, instead of using cheese, meat or croutons in your salad, add a handful of walnuts or almonds. 4. Olive oil Olive oil contains a potent mix of antioxidants that can lower your "bad" (LDL) cholesterol but leave your "good" (HDL) cholesterol untouched. Try using about 2 tablespoons (23 grams) of olive oil a day in place of other fats in your diet to get its heart-healthy benefits. To add olive oil to your diet, you can saute vegetables in it, add it to a marinade or mix it with vinegar as a salad dressing. You can also use olive oil as a substitute for butter when basting meat or as a dip for bread. Olive oil is high in calories, so don't eat more than the recommended amount. The cholesterol-lowering effects of olive oil are even greater if you choose extra-virgin olive oil, meaning the oil is less processed and contains more heart-healthy antioxidants. But keep in mind that "light" olive oils are usually more processed than extra-virgin or virgin olive oils and are lighter in color, not fat or calories. 5. Foods with added plant sterols or stanols Foods are now available that have been fortified with sterols or stanols substances found in plants that help block the absorption of cholesterol. Margarines, orange juice and yogurt drinks with added plant sterols can help reduce LDL cholesterol by more than 10 percent. The amount of daily plant sterols needed for results is at least 2 grams which equals about two 8-ounce (237-milliliter) servings of plant sterol-fortified orange juice a day. Plant sterols or stanols in fortified foods don't appear to affect levels of triglycerides or of highdensity lipoprotein (HDL), the "good" cholesterol.

Other changes to your diet For any of these foods to provide their benefit, you need to make other changes to your diet and lifestyle. Cut back on the cholesterol and total fat especially saturated and trans fats that you eat. Saturated fats, like those in meat, full-fat dairy products and some oils, raise your total cholesterol. Trans fats, which are sometimes found in margarines and store-bought cookies, crackers and cakes, are particularly bad for your cholesterol levels. Trans fats raise low-density lipoprotein (LDL), the "bad," cholesterol, and lower high-density lipoprotein (HDL), the "good," cholesterol. In addition to changing your diet, keep in mind that making additional heart-healthy lifestyle changes are key to lowering your cholesterol. Talk to your doctor about exercising, quitting smoking and maintaining a healthy weight to help keep your cholesterol level low.

Released online Tuesday in the Journal of the American Medical Assn., the study found that incorporating several cholesterol-lowering foods such as soy protein and nuts into a diet can reduce bad cholesterol far more effectively than a diet low in saturated fat. One of the most potent cholesterol-busters in that mix, plant sterols (sometimes called stanols), occurs in small amounts in many grains, nuts, vegetables, legumes and fruits and also can be added to foods or taken as a dietary supplement. Plant sterols mimic LDL cholesterol particles in the gut, preventing the absorption of those particles so that they pass through the body and are disposed of as waste 1. SMART FOODS WHAT These include Flora pro.activ and Benecol yogurt shots, as well as other products containing stanols and sterols. These naturally occurring molecules, which are found in plants, block the absorption of dietary cholesterol, which is then excreted with other waste. PROOF Studies have shown that plant sterols reduce cholesterol levels by seven to ten per cent within three weeks, as part of a diet low in saturated fat. DOSE You need to consume 2g in one go alongside your biggest meal of the day, each day, to get the full effect. The best form is the yogurt shot drinks that provide this amount of plant sterols alongside just under 40 calories and 1.4g of fat. You need to eat six teaspoons of fortified margarine to get the same amount of sterols, which delivers 150 calories and 18g of fat, although low-fat margarines with sterols are now also available.

EXPERT ADVICE Drink with your main meal as sterols reduce the amount of fat absorbed. A shot with your morning coffee or little bits of margarine through the day will not produce the same benefits, says Catherine Collins, principal dietician at St Georges Healthcare NHS Trust. 2. FIBRE WHAT The high fermentable-fibre content of beans and pulses means that they cannot be digested easily by the gut. This fibre binds to cholesterol so that it is removed through waste. High-fibre bread can be added to the diet to boost fibre intake further. PROOF A meta-analysis of 67 studies on dietary fibre and cholesterol levels revealed that consuming more fibre helped reduce bad LDL cholesterol by a small but significant amount. Fibrous foods such as beans also trick the body into absorbing less saturated fat, which can help control weight and protect arteries from heart disease. DOSE Eighteen grams a day. Around 5g will come from oat-based products and you can get the rest from just a slice of high-fibre toast and two tablespoons of beans. Fruit and veg will also boost fibre intake. EXPERT ADVICE Just swapping white bread for wholemeal can lower cholesterol levels, a manageable step for everyone. Its easy for most people to add fibre to their diet, says Linda Main, of the cholesterol charity HEART UK. 3. NUTS WHAT Most nuts, including almonds, walnuts, pecans and peanuts, are good for lowering cholesterol. However, avoid salted varieties, especially if you have raised blood pressure. It is not clear how nuts lower cholesterol, but it might be because they contain plant sterols as well as monounsaturated fats that protect blood vessels from damage. They are also high in fibre and Vitamin E. PROOF In 2010, an American analysis of 25 studies on nut consumption and blood fat levels found that eating a portion every day (eight to ten nuts, or a small palm-full) reduced overall cholesterol by five per cent and was particularly good for people with high levels of bad LDL cholesterol. DOSE

Between 25g and 50g of nuts daily. EXPERT ADVICE Linda Main says: Nuts are very filling, so not only do they reduce cholesterol, but they can stop you snacking on too many other fatty foods afterwards. While nuts are in theory very calorific, it is unlikely all the energy is available to the body. 4. SOYA WHAT Soya milk, soy nuts, tofu and soya yogurts may help the liver to take bad LDL cholesterol out of the bloodstream. Using soya to replace dairy and meat can also displace saturated fat from the diet. PROOF There is some evidence, including a 2011 study, that soy protein can help reduce total cholesterol. Although the effects were modest, some experts say that because soy products such as tofu often replace meat in the diet, they reduce the intake of saturated fat from other sources. DOSE Experts recommend having at least two to three portions a day. That is equivalent to half a litre of soya milk and a soya yogurt. The reduction in cholesterol may be as much as five per cent, but scientific proof for this is limited. EXPERT ADVICE Start with one portion a day and slowly build it into the diet from there. If you dont like soya, follow the other tips instead, advises Catherine Collins. 5. HEALTHY OILS WHAT Olive oil and rapeseed oil, which contain mainly monounsaturated fats, neither increase nor decrease cholesterol levels. However, they help to make the artery walls stronger, meaning that they are less likely to be damaged by cholesterol. These fats are also cleared easily by the body. PROOF Studies suggest that replacing saturated fat such as lard and butter with these oils results in a fall in cholesterol. It may also stop LDL causing inflammation in the arteries, a key risk factor for cardiovascular disease. DOSE Two tablespoons a day used in cooking. A 2002 study found that consuming this amount of olive

oil each day decreased total cholesterol by eight per cent in six weeks. Generally, studies suggest that virgin olive oil is best. EXPERT ADVICE Polyunsaturated fats from sunflower oils were considered to be as good as olive oils, but recently it has emerged that having too much of them causes oxidation, meaning they may increase furring of the arteries. However, remember that polyunsaturated fats are still better than butter and lard. 6. OATS WHAT Oats contain compounds called beta glucans, which give them their paste-like consistency. The beta glucans form a thick gel inside the digestive tract and bind to cholesterol in the gut, helping to prevent cholesterol from being absorbed by the body. The gel and cholesterol are then excreted as waste. PROOF Analysis of 12 studies involving more than 1,000 people showed that adding beta glucans each day to your diet via porridge, other oat-based cereals and oatcakes reduced cholesterol by up to five per cent within three months. DOSE Three grams of beta glucans a day. This is equivalent to a small bowl of porridge, three oatcakes and two slices of oat bread. This would also contribute about 5g of your daily fibre intake (see panel, left). EXPERT ADVICE Studies show beta glucan is good for heart health and its easy to eat more oats, says Linda Main. There are now even breads with added oat bran. But people need to try to eat three portions a day on a regular basis to have an effect. HEART UK have an Ultimate Cholesterol Lowering Plan fact sheet that explains it all.

In with the good Different foods lower cholesterol in various ways. Some deliver soluble fiber, which binds cholesterol and its precursors in the digestive system and drags them out of the body before they get into circulation. Some give you polyunsaturated fats, which directly lower LDL. And some contain plant sterols and stanols, which block the body from absorbing cholesterol. Oats. An easy first step to improving your cholesterol is having a bowl of oatmeal or cold oatbased cereal like Cheerios for breakfast. It gives you 1 to 2 grams of soluble fiber. Add a banana or some strawberries for another half-gram. Current nutrition guidelines recommend getting 20

to 35 grams of fiber a day, with at least 5 to 10 grams coming from soluble fiber. (The average American gets about half that amount.) Barley and other whole grains. Like oats and oat bran, barley and other whole grains can help lower the risk of heart disease, mainly via the soluble fiber they deliver. Beans. Beans are especially rich in soluble fiber. They also take awhile for the body to digest, meaning you feel full for longer after a meal. That's one reason beans are a useful food for folks trying to lose weight. With so many choices from navy and kidney beans to lentils, garbanzos, black-eyed peas, and beyond and so many ways to prepare them, beans are a very versatile food. Eggplant and okra. These two low-calorie vegetables are good sources of soluble fiber. Nuts. A bushel of studies shows that eating almonds, walnuts, peanuts, and other nuts is good for the heart. Eating 2 ounces of nuts a day can slightly lower LDL, on the order of 5%. Nuts have additional nutrients that protect the heart in other ways. Vegetable oils. Using liquid vegetable oils such as canola, sunflower, safflower, and others in place of butter, lard, or shortening when cooking or at the table helps lower LDL. Apples, grapes, strawberries, citrus fruits. These fruits are rich in pectin, a type of soluble fiber that lowers LDL. Foods fortified with sterols and stanols. Sterols and stanols extracted from plants gum up the body's ability to absorb cholesterol from food. Companies are adding them to foods ranging from margarine and granola bars to orange juice and chocolate. They're also available as supplements. Getting 2 grams of plant sterols or stanols a day can lower LDL cholesterol by about 10%. Soy. Eating soybeans and foods made from them, like tofu and soy milk, was once touted as a powerful way to lower cholesterol. Analyses show that the effect is more modest consuming 25 grams of soy protein a day (10 ounces of tofu or 2 1/2 cups of soy milk) can lower LDL by 5% to 6%. Fatty fish. Eating fish two or three times a week can lower LDL in two ways: by replacing meat, which has LDL-boosting saturated fats, and by delivering LDL-lowering omega-3 fats. Omega3s reduce triglycerides in the bloodstream and also protect the heart by helping prevent the onset of abnormal heart rhythms. Fiber supplements. Supplements offer the least appealing way to get soluble fiber. Two teaspoons a day of psyllium, which is found in Metamucil and other bulk-forming laxatives, provide about 4 grams of soluble fiber. Out with the bad

Harmful LDL creeps upward and protective HDL drifts downward largely because of diet and other lifestyle choices. Genes play a role, too some people are genetically programmed to respond more readily to what they eat but genes aren't something you can change. Here are four things you can: Saturated fats. The saturated fats found in red meat, milk and other dairy foods, and coconut and palm oils directly boost LDL. So one way to lower your LDL is to cut back on saturated fat. Try substituting extra-lean ground beef for regular; low-fat or skim milk for whole milk; olive oil or a vegetable-oil margarine for butter; baked fish or chicken for fried. Trans fats. Trans fats are a byproduct of the chemical reaction that turns liquid vegetable oil into solid margarine or shortening and that prevents liquid vegetable oils from turning rancid. Trans fats boost LDL as much as saturated fats do. They also lower protective HDL, rev up inflammation, and increase the tendency for blood clots to form inside blood vessels. The Institute of Medicine recommends getting no more than two grams of trans fats a day; less is even better. Although trans fats were once ubiquitous in prepared foods, many companies now use trans-free alternatives. Some restaurants and fast-food chains have yet to make the switch. Weight and exercise. Being overweight and not exercising affect fats circulating in the bloodstream. Excess weight boosts harmful LDL, while inactivity depresses protective HDL. Losing weight if needed and exercising more reverse these trends. Putting it all together When it comes to investing money, experts recommend creating a portfolio of diverse investments instead of putting all your eggs in one basket. The same holds true for eating your way to lower cholesterol. Adding several foods that fight high cholesterol in different ways should work better than focusing on one or two. That approach has been tested by Dr. David Jenkins of St. Michael's Hospital in Toronto and his colleagues. In a series of studies, their largely vegetarian "dietary portfolio of cholesterollowering foods" substantially lowered LDL, triglycerides, and blood pressure. The portfolio included margarine enriched with plant sterols; oats, barley, psyllium, okra, and eggplant, all rich in soluble fiber; soy protein; and whole almonds. These were added to a diet with plenty of fruits and vegetables, whole grains instead of highly refined ones, and protein mostly from plants. Of course, shifting to a cholesterol-lowering diet takes more attention than popping a daily statin. It means expanding the variety of foods you usually put in your shopping cart and getting used to new textures and flavors. But it's a "natural" way to lower cholesterol, and it avoids the risk of muscle problems and other side effects that plague some people who take statins. Just as important, a diet that is heavy on fruits, vegetables, beans, and nuts is good for the body in ways beyond lowering cholesterol. It keeps blood pressure in check. It helps arteries stay

flexible and responsive. It's good for bones and digestive health, for vision and mental health. That's a portfolio worth protecting.