If you have high cholesterol, your primary objective should be to find a way to lower 1 it without drugs and their side effects. The good news is that just eating the right foods often can reduce cholesterol by 50 points or more.

Most people know to eat a low-fat diet, but there are certain foods that can help lower cholesterol that may surprise you…

Macadamia Nuts

Macadamia nuts are among the fattiest plant foods on the planet, about 76% total fat by weight. However, nearly all of the fat is monounsaturated. This type of fat is ideal because it lowers LDL (bad) cholesterol without depressing HDL (good) cholesterol.

A team at Hawaii University found that study participants who added macadamia nuts to their diets for just one month had total cholesterol levels of 191 milligrams per deciliter (mg/dL), compared with those eating the typical American diet (201 mg/dL). The greatest effect was on LDL cholesterol.

Macadamia nuts are higher than other nuts in monounsaturated fat, but all nuts are high in vitamin E, omega-3 fatty acids and other antioxidants. Data from the Harvard Nurses' Health Study found that people who ate at least five ounces of any kind of nut weekly were 35% less likely to suffer heart attacks than those who ate less than one ounce per month.

Caution: Moderation is important because nuts-macadamia nuts, in particular-are high in calories. Limit servings to between one and two ounces daily-about a small handful a day.

Rhubarb

Rhubarb is ideal for both digestive health and lowering cholesterol because it contains a mix of soluble (see "Oats" below) and insoluble fibers.

A study reported in Journal of the American College of Nutrition found that participants who ate a little less than three ounces of rhubarb daily for four weeks had an average drop in LDL cholesterol of 9%.

This tart-tasting vegetable isn't only an ingredient in pies. You can cut and simmer the stalks and serve rhubarb as a nutritious side dish (add some low-calorie strawberry jam for a touch of sweetness).

Rice Bran

It's not as well-known for lowering cholesterol as oats and oat bran, but rice bran is just about as effective and some people enjoy it more. A six-week study at University of California, Davis Medical Center found that people who ate three ounces daily of a product with rice bran had drops in total cholesterol of 8.3% and a reduction in LDL of 13.7%.

You can buy rice bran in most supermarkets, it's prepared like oatmeal. Or you can try prepared rice-bran breakfast cereals, such as Quaker Rice Bran Cereal and Kenmei Rice Bran.

Red Yeast Rice

Made from a yeast that grows on rice, red yeast rice contains monacolins, compounds that inhibit the body's production of cholesterol.

One study found that people who took red yeast rice supplements and did nothing else had drops in LDL of 23%. When the supplements were combined with healthy lifestyle changes, their LDL dropped by about 42%.

Red yeast rice may be less likely than statins to cause the side effect myopathy (a painful muscle disease).

Recommended dose: 600 milligrams (mg), twice daily. It is available online and at health-food stores.

Green Tea

Green tea is a concentrated source of polyphenols, which are among the most potent antioxidants. It can lower LDL cholesterol and prevent it from turning into plaque deposits in blood vessels. In one study, men who drank five cups of green tea daily had total cholesterol levels that were nine points lower than men who didn't drink green tea.

Three to five cups daily are probably optimal. Black tea also contains polyphenols but in lower concentrations than green tea.

Vitamins C and E

These vitamins help prevent cholesterol in the blood from oxidizing. Oxidized cholesterol is more likely to cling to artery walls and promote the development of atherosclerosis, the cause of most heart attacks.

I advise patients with high cholesterol to take at least 400 international units (IU) of d-alpha tocopherol, the natural form of vitamin E, daily. You might need more if you engage in activities that increase oxidation, such as smoking.

For vitamin C, take 1,000 mg daily. People who get the most vitamin C are from 25% to 50% less likely to die from cardiovascular disease than those who get smaller amounts.

The Big Three

In addition to the above, some foods have long been known to reduce cholesterol, but they are so helpful that they bear repeating again…

  • Cholesterol-lowering margarines. I use Benecol every day. It's a margarine that contains stanol esters, cholesterol-lowering compounds that are extracted from plants such as soy and pine trees. About 30 grams (g) of Benecol (the equivalent of about three to four pats of butter) daily will lower LDL by about 14%.

Similar products, such as Promise Buttery Spread, contain sterol esters. Like stanols, they help block the passage of cholesterol from the digestive tract into the bloodstream. We used to think that sterols weren't as effective as stanols for lowering cholesterol, but they appear to have comparable benefits.

  • Oats. They are among the most potent nutraceuticals, natural foods with medicine-like properties. Both oat bran and oatmeal are high in soluble fiber. This type of fiber dissolves and forms a gel-like material in the intestine. The gel binds to cholesterol molecules, which prevents them from entering the bloodstream. A Harvard study that analyzed the results of 67 scientific trials found that even a small amount of soluble fiber daily lowered total cholesterol by five points. People who eat a total of 7 g to 8 g of soluble fiber daily typically see drops of up to 10%. One and a half cups of cooked oatmeal provides 6 g of fiber. If you don't like oatmeal, try homemade oat bran muffins. Soluble fiber also is found in such foods as kidney beans, apples, pears, barley and prunes.
  • Fish. People who eat two to three servings of fish a week will have significant drops in both LDL and triglycerides, another marker for cardiac risk. One large study found that people who ate fish as little as once a week reduced their risk for a sudden, fatal heart attack by 52%.

I eat salmon, tuna, herring and sardines. Other good sources of omega-3 fatty acids include walnuts, ground flaxseed, tofu and canola oil.

Fish-oil supplements may provide similar protection, but they are not as effective as the natural food, which contains other beneficial nutrients as well.

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