My brother had just recently had a full body checkup. The results weren’t perfect but not bad.
But one thing on the report got me worried
His cholesterol level was tested to be on the high side.
Here’s why I’m worried:
As a pharmacist for more than 7 years, I know that cholesterol problems are very “sticky”. They don’t normally just “go away” and most people need cholesterol medications to help control it.
The word i hated most – CONTROL. Controlling a condition is not the same as treating a condition. When you use a medication to CONTROL a condition, it basically means that you will need to use the meds for the rest of your life.
And my brother is not even 30 years old!
But it’s ok, I know that there are ways to lower cholesterol levels without going on medications. (And I’m going to share it here)
Cholesterol 101: Brief introduction
Cholesterol is a fat-like, waxy substance found in all cells of the body.
Mainly, there are two types of cholesterols: The “good” one and the “bad” one. The “good” cholesterol, a.k.a High Density Lipoproteins (HDL) helps to lower cholesterol levels. HDL transport the cholesterol in the blood to the liver. The liver then gets rid of the cholesterol. The “bad” cholesterol, a.k.a Low Density Lipoproteins (LDL) can lead to formation of heart disease, stroke, heart attack, high blood pressure etc.
When you have high “bad” cholesterol, you are more likely to get heart disease. The LDL found in blood can form plaques (along with calcium, fat and other substances) around your blood vessels.
Plaques cause your blood vessels to become narrower, and can sometimes cause complete blockade. If the blockade happens to a blood vessel to the brain, it’s called a stroke. If it’s a blood vessel to the heart, it’s called a heart attack.
Medications are usually required for maintaining healthy cholesterol levels. But as mentioned before, once you have started on a cholesterol medication, you are supposed to continue taking it for the rests of your lives.
Here are some ways you can try to lower cholesterol levels before going on medications
Exercise your way to lower cholesterol
The benefits of exercise cannot be over-emphasized.
Exercising helps to increase the “good” cholesterol (HDL) in your body. HDL, as mentioned above, carry the cholesterol back to the liver. By having more HDL, you will get lower cholesterol in the blood. Lower cholesterol in the blood means less chance of having fat deposits around the blood vessels.
Doing more physical exercise will also help to reduce your weight. Though unclear, it was found that people overweight are more likely to have higher LDL levels ( the “bad” cholesterol).
Wondering how much exercise is enough? There is no right or wrong answer here. Just remember:
“some exercise is better than none, and more exercise is better than some.”
We recommend try an exercise programme along with diet change for at least one month before you start on cholesterol medications. If you have not exercised for a while, you can start by going for a short walk for 30 minutes every day.
20% of the cholesterol in our body comes from food. The other 80% comes from our liver.
We can’t really do much about the 80% that comes from our liver. It’s pre-determined by our genes. (Explains why you are more likely to get cholesterol problems if your father or mother had it)
But the other 20% is where you can work on. To get lower cholesterol, simply take in less cholesterol.
If you are like my brother, in your 20s and working a fulltime job, chances are you will be eating out a lot. (especially if you are not living with your mother). Some of you might also be drinking a fair bit.
Unhealthy food and drinking are two of the most common causes of high cholesterol.
To reduce your cholesterol levels, you have to be mindful with your fats intake. In particular, you have to limit the intake of saturated fats and trans-fat. (the “bad” fats)
How can you start monitoring your diet for cholesterol and saturated fat
- Keep in mind that the recommended daily intake for cholesterol and saturated fat are 300mg and 24g respectively. As for trans-fat, the daily intake should be 0 if possible!
- Go to MyFitnessPal food calorie tracker
- Type in your food
- Examine the cholesterol content and saturated fat in that particular food.
- Try not to exceed the recommended daily intake
Char Kuey Teow – Malaysians favourite street food has the following nutritional profile:
insert calorie pic here
As you can see, one serve of Char Kuey Teow gives you 234mg of cholesterol and 29g of saturated fat. That almost 80% of your recommended cholesterol intake and more than 100% of recommended saturated fat intake.
Well, not sure about you but no more Char Kuey Teow for my brother and I for sure. (at least for a while)
Note: MyFitnessPal has one of the biggest database for foods nutritional facts, but it’s still not very complete, and some information might not be accurate. If in doubt, just google your food‘s nutrition information (e.g Nasi Lemak’s nutrition information)
Superfood to lower cholesterol: Oatmeal, oat bran, and high fibre foods
There are plenty of evidence to support the use of oatmeal products for cholesterol reduction. (1) In 1997, FDA in the U.S even gave the status of “health claim” to oatmeal products. This allows manufacturers to advertise the heart-healthy benefits on boxes of oatmeal products.
It’s not entirely sure how high fibre products can lower cholesterol yet. One widely accepted explanation is that when we digest fibre, it becomes sticky and sticks to cholesterol and stops it from being absorbed. (2)
Another study also found that oatbran products lower blood cholesterol at least in part by changing how the liver processes cholesterol. (3)
In other words, oat products can help reduce cholesterol absorbed from food as well as cholesterol produced in the body. (Remember, only 20% of cholesterol comes from diet)
There are plenty of oatmeal products available on the market. (For e.g. Quick cook oats, instant oats, oatbran powders, psyllium husks etc.) How do you choose the right one?
Again, there is no right or wrong answer. Any is better than none, and more is better than some.
One thing you need to know though, is that the cholesterol lowering effect of oats comes mainly from this active ingredient: Beta-Glucan (4,5). In other words, the higher the Beta-Glucan content, the more powerful its cholesterol lowering effect.
*Most Beta-Glucan Oat bran powder in Malaysia have 20% Beta-glucan only. Due to regulatory restrictions, products that contain more than 20% of the active ingredient need to be registered as health supplements instead of health foods. (Stricter requirements will be implied on health supplements). Remember to always check the content label on the can before buying the oatbran powder. Kordel’s active oat-35 might not necessarily be better than Oats BG-22, as they both contain 20% beta-glucan only (Despite the name 35 and 22 respectively)
Supplements for cholesterol reduction: Fish Oil
Fish oil offers many benefits, one of them is to lower cholesterol levels. Unlike oat products, fish oil does not reduce LDL much. Instead, it reduces the other “bad” cholesterol-related substance called Triglycerides, and helps to increase the “good” cholesterol HDL.
Strictly speaking, triglycerides are different from cholesterol, eventhough we take it into account when working out the total cholesterol. Triglycerides, unlike cholesterols (LDL and HDL), are not used to build cells or hormones. In simple terms, they are fats in the blood that can be converted to energy when needed.
High triglyceride contributes to high total cholesterol. High triglyceride is also linked to higher risk of heart disease and pancreatitis (6).
Fish oil is very rich in Omega-3 fatty acids. Omega-3 fatty acids are by far the most effective triglyceride reducing agent. Ounce for ounce, omega-3 fatty acids are at least 10-fold more potent for triglyceride reduction than any other food oil. (7)
To find the best fish oil, always read the label, and check the omega-3 content in each bottle. The same 1000mg fish oil might have different amount of EPA and DHA in them. So always remember to check for EPA and DHA.
The recommended daily dose for triglycerides reduction is about 1200mg of EPA and DHA combined. Most fish oil brands contain 180mg of EPA and 120mg DHA, that means you will need about four standard capsules a day.
Alternative supplement for lower cholesterol: Red Yeast Rice
Red yeast rice is a traditional chinese medicine used to lower cholesterol. It is extracted from rice that has been fermented with a type of yeast called Monascus purpureus.
Red yeast rice contains a few ingredients that are beneficial for cholesterol reduction. The list includes several types of monacolin, sterols, isoflavones and monosaturated fatty acids (“good” fats). Amongst these ingredients, monacolin K has the most effect on cholesterol lowering.
Monacolin K is also known as Lovastatin, which is a cholesterol lowering drug (brand name “Lestric”). Compared to oatmeal products and fish oil, red yeast rice is not as well researched.
There are however, several research that showed the effectiveness of red yeast rice in cholesterol reduction (8,9,10). Due to its similarity to prescription drug lovastatin, it is recommended that you seek for doctor’s or pharmacist’s advice before taking it, especially if you are on other medications. If you want to try a food supplement before going on medication and if you are not pregnant, breastfeeding or using any other medications – you could consider taking red yeast rice.
Red yeast rice supplement brands in Malaysia
Each capsule contains 600 mg Monascus Purpureus Went yeast fermented on premium rice
Recommended dosage: 2 capsules twice a day (morning & evening) after meals.
Bio-life Red Yeast Rice
Each capsule contains 575mg of red yeast rice
Recommended dosage: One capsule daily with food or as recommended by your pharmacist.
*note: I believe this dose (650mg per day) is a bit too low. Need further clarification from Bio-life.
The methods listed in this post have substantial evidence that supports their use. Other supplements such as plant sterols, tocopherol, vitamin E etc, are not that popular (yet), so they are not listed in this post.
If you are looking for ways to reduce your cholesterol before you go on medications, try the above methods or supplements.
What do you think? Will you try them? or if you have tried any of the above methods/supplements, tell us how did you go.
Feel free to leave a comment below and share your thoughts with the rest of us.
- Kirby, Robert W., et al. “Oat-bran intake selectively lowers serum low-density lipoprotein cholesterol concentrations of hypercholesterolemic men.”The American journal of clinical nutrition 34.5 (1981): 824-829.
- Griffin, R. Morgan. “LDL Cholesterol and Oatmeal.” WebMD. WebMD. Web. 20 Jan. 2016. <http://www.webmd.com/cholesterol-management/features/the-new-cholesterol-diet-oatmeal-oat-bran>.
- Marlett, Judith A., et al. “Mechanism of serum cholesterol reduction by oat bran.” Hepatology 20.6 (1994): 1450-1457.
- Queenan, Katie M., et al. “Concentrated oat β-glucan, a fermentable fiber, lowers serum cholesterol in hypercholesterolemic adults in a randomized controlled trial.” Nutrition Journal 6.1 (2007): 6.
- Braaten, J. T., et al. “Oat beta-glucan reduces blood cholesterol concentration in hypercholesterolemic subjects.” European Journal of Clinical Nutrition 48.7 (1994): 465-474.
- Yuan, George, Khalid Z. Al-Shali, and Robert A. Hegele. “Hypertriglyceridemia: its etiology, effects and treatment.” Canadian Medical Association Journal 176.8 (2007): 1113-1120.
- Harris, William, Dr. “How Does Fish Oil Reduce Triglycerides.” Health Central. 10 Nov. 2009. Web. 21 Jan. 2016. <http://www.healthcentral.com/cholesterol/c/7986/94321/triglycerides/>.
- Heber, David, et al. “Cholesterol-lowering effects of a proprietary Chinese red-yeast-rice dietary supplement.” The American journal of clinical nutrition69.2 (1999): 231-236.
- Li, Changling, et al. “Monascus purpureus-fermented rice (red yeast rice): a natural food product that lowers blood cholesterol in animal models of hypercholesterolemia.” Nutrition Research 18.1 (1998): 71-81.
- Wang, Junxian, et al. “Multicenter clinical trial of the serum lipid-lowering effects of a Monascus purpureus (red yeast) rice preparation from traditional Chinese medicine.” Current Therapeutic Research 58.12 (1997): 964-978.