2024 July

I have had a couple of friends who recently discovered that their cholesterol levels were elevated. This got me thinking about all the actions we can take to help keep our cholesterol at optimum levels. I initially thought about writing an article with a quick list of actions, but I realized that there are a lot of those types of articles out there already. I have decided to break down the subject of cholesterol management into a few key areas and explore those areas more thoroughly. I think the best place to start is with the subject of fiber.

One of the primary dietary recommendations in managing your cholesterol is to eat more fiber. The purpose of this article is to help you understand fiber and how to incorporate more fiber into your daily diet in a way that can make a noticeable, positive difference in your health. 

In this article, I will provide the following: 

• An overview of cholesterol and healthy cholesterol targets
• Some dietary recommendations
• A review of recommended fiber intake for men and women
• A definition of each: soluble fiber versus insoluble fiber
• A list of high fiber foods
• Sample food combinations to meet daily fiber recommendations 
• Links to some high fiber recipes

Overview of Cholesterol

What is Cholesterol

Cholesterol, as described by the Center of Disease Control and Prevention, is a “waxy, fat-like substance made by your liver. Blood cholesterol is essential for good health. Your body needs it to perform important jobs, such as making hormones and digesting fatty foods.”  All the cholesterol your body needs is produced by your liver. Your liver produces Low Density Lipid Proteins (LDL) and High-Density Lipid Proteins (HDL). 

HDL is considered the “good” cholesterol and LDL is considered the bad cholesterol. The High-Density Lipid Proteins collect cholesterol from blood vessel walls and carry it back to the liver for disposal. The Low-Density Lipid proteins carry cholesterol to our blood vessels and dump it there.

Risks Associated with High Cholesterol

When our LDL cholesterol is high, we run the risk of creating a waxy build-up in our blood vessels, which is known as atherosclerosis. When our blood vessels narrow, this can lead to high blood pressure. When chunks of this waxy build-up suddenly break off, they can cause heart attacks or strokes, or other life-threatening cardiovascular events. My mom suffered a stroke and had to have part of her brain removed, so prevention of cardiovascular disease is near and dear to my heart. I have spent a great deal of time understanding what causes a stroke and what actions can be taken to avoid them. I am happy to share what I have learned with you. 

Healthy Cholesterol Targets:

When it comes to total cholesterol, LDL, and HDL there are some general targets from the American Heart Association and the American College of Cardiology 

Total Cholesterol: Less than 200

Low-Density Lipoprotein:  Less than 100 mg/dL

High Density Lipoprotein: 60mg/dL or above

“If there is a family history of cardiovascular disease, the recommended LDL target is <70mg/dL. “Studies have shown that when LDL falls below this number (70), plaques in arteries get smaller and they stabilize, which lowers the risk for heart attacks and stroke.”

Dr. Christopher Cannon, editor in chief of the Harvard Heart Letter.

Quick Dietary Recommendations

Reducing intake of animal products and highly processed foods while increasing whole, plant-based foods and fiber is recommended. In his seminal book Reversing Heart Disease, Dr Dean Ornish details the role of a plant-based diet in reversing heart disease. For over 37 years, Dr Ornish has been helping people reverse heart disease (even reduce arterial plaque) with diet.  Here is a PDF overview of the diet Dr. Ornish recommends. https://www.ornish.com/wp-content/uploads/Participant-Nutrition-Overview.pdf

The Ornish protocol is a great solution for those who are ready to make changes in their diet. I recognize that these changes may seem a bit too restrictive for some of us, so I will offer an alternative below. I should clarify that I do recommend working toward the Ornish protocol, especially if you have already been diagnosed with a cardiovascular disease. In the meantime, let’s discuss some general guidelines that will get you started. 

The only foods that contain cholesterol are animal products.  Meat, cheese, milk and butter contain cholesterol and saturated fat. Plants do not contain cholesterol, so a plant-based, mainly vegetarian diet is recommended to help lower one’s LDL, blood pressure and triglycerides. You do not have to cut out meat completely just limit your meat consumption. If you are going to eat meat, aim for a serving that is about the size of a deck of cards and always include plenty of vegetables with every serving of meat. I will review protein consumption in more detail for you in a later article.

In addition, alcohol has been shown to cause the liver to raise LDL cholesterol production. Abstain from alcohol, if possible. If you must drink, limit consumption to no more than 3 alcoholic drinks in a week. 

Now that we have a basic understanding of cholesterol. I want to focus on fiber, because fiber reduces the cholesterol in the blood. If you remember nothing else from this article, just remember that fiber can reduce the amount of cholesterol in your blood. Let’s take a closer look at fiber consumption:

The recommended fiber intake for men and women

Here is the recommended daily amount of fiber for men and women: 

MEN: 

<50 years of age:  38 grams

>50 years of age:  30 grams

WOMEN: 

<50 years of age:  25 grams

>50 years of age:  21 grams

Tracking grams of fiber can be time consuming, so it might be easier to simply think of the fiber consumption in terms of foods:

• two to four servings of fruit
• two to five servings of vegetables, whole grains, and legumes; and 
• one to two servings of nuts and seeds

Soluble fiber vs Insoluble fiber

There are 2 types of fiber: soluble and insoluble fiber. Each plays an important role in our digestion and overall health. Soluble fiber, as the name suggests, dissolves in water. When it dissolves, it forms a gel and this gel is pretty amazing. It clears excess cholesterol from our blood. It regulates cholesterol levels and sugar levels and reduces the risk of heart disease. In contrast, insoluble fiber does not dissolve in water, so it travels through the digestive tract pretty much intact. It adds bulk to stools which prevents constipation and regulates bowel movements. It ensures that waste is removed from the body in a timely manner. In the Ayurvedic tradition, it is believed that food that sits too long in our intestines will putrefy. The toxins, that result from stagnate digestion, are considered the root cause of disease. Eating an appropriate amount of fiber can help us digest our food at a pace that will maximize nutrient absorption and minimize constipation. 

Here are some examples of soluble fiber and insoluble fiber sources: 

Examples of soluble fiber include:  apples, oats, blueberries, lima beans, Brussels sprouts, sweet potato, broccoli, turnips, pears, citrus fruits, cucumbers

Examples of insoluble fiber include: whole wheat flour, wheat bran, cauliflower, green beans, bananas, potatoes, fruits with edible peels, and nuts., 

Rather than trying to figure out whether you are eating soluble fiber or insoluble fiber, it’s best to simply aim for eating a total amount of fiber each day. Also, when we examine fiber content more closely, we realize that many high fiber foods contain both soluble fiber and insoluble fiber. For example, lentils, beans, avocados, and peanut butter contain both soluble and insoluble fiber. 

Adequate Daily Fiber 

I created a list of foods and ranked them by the amount of fiber they contain. I also created specific examples of daily menus that meet the recommended fiber intake for men and women. In addition, I included links to some high fiber recipes that I have published on my website.  

If you are currently eating low amounts of fiber. Increase your fiber intake gradually. Give your digestion time to acclimate. When you increase your fiber intake too rapidly, you may experience gas or bloating. Don’t worry this will subside. 

One more note, there are fiber supplements available, but it is best to get your fiber from whole foods. When you eat whole foods, the fiber is packed with additional nutrients such as vitamins, minerals, antioxidants, polyphenols, amino acids and water. All of these nutrients work together in this amazing biologically synergistic manner to improve your health. Supplements are fine in a pinch, but they cannot quite achieve what natural whole foods can. Plant foods have thrived and evolved for thousands of years, and their nutrients work in these amazing synergistic ways that we have yet to fully comprehend. 

A List of High Fiber Foods:

Quantity	Food	Fiber(in grams)
Grains
1 cup	bulgur	8.2
1 cup	kamut	7.4
1 cup	barley	6
1/2 cup	granola	5.5
1/2 cup	oatmeal	4.8
1 cup	pasta whole wheat	4.6
1 cup	brown rice	3.5
1 cup	pasta enriched	2.2
2	corn tortilla	2
Legumes
1 cup	lentils	16
1 cup	black beans	15
1 cup	pinto beans	15
1 cup	chickpeas	12
Vegetables
1 cup	green peas	8.8
1 cup	sweet potato, with skin	6.6
1 cup	kale	5.72
1 cup	green beans	3.9
1 cup	potato, with skin	3.3
1/2 cup	broccoli	2.6
1 cup	eggplant	2.5
1 cup	broccoli	2.4
1/2 cup	carrots	2.3
1 cup	cabbage	2.2
1 cup	cucumber	2
1/2 cup	brussels sprouts	2
1 cup	spinach, raw	0.7
Fruits
1	sm avocado	9.3
1	kiwi	5.4
1	apple, small	3.6
1 cup	tomato, raw	3.2
1	orange	3.1
1	banana	3.1
1 cup	strawberries	3
1 cup	mango	2.6
1 cup	papaya	2.5
1 cup	pineapple	2.3
3	prunes	2
Nuts & Seeds
2 tbsp	chia seeds	9.4
1 cup	quinoa	5.2
23	almonds	4
1/4 cup	sunflower seeds, raw	3
8	pecans	2.7
2 tbsp	peanut butter, chunky	2.6
7	walnuts	1.9
1/4 cup	pumpkin seeds, raw	1.875
3 tbsp	hemp seed	1.2
Other Foods
1/2 cup	plain yogurt	0
1oz	cheese	0
4oz	sirloin	0
8oz	oven roasted chicken	0
1 cup	pork chop	0
1 cup	whole milk	0
2 tbsp	olive oil	0

Food Combinations to Meet Daily Recommendations

Men’s Daily Recommended Intake: 30-38g per day

In a single day, you could eat the foods below to meet the daily recommended (fiber) intake.

Note: Additional foods would most likely need to be added to meet protein DRI or daily caloric requirements. These examples are simply highlighting fiber requirements irrespective of other nutrient requirements.

Example 1:
Qty	Food	Fiber (in grams)
2	corn tortillas	2
1/2 cup	pinto beans	7.5
1/2	avocado, small	4.65
1 cup	lentils	16
1/2 cup	brown rice	1.75
1/2 cup	green beans	1.95
1/2 cup	carrots	2.3
Total Fiber:		36.15
Example 2:
1/2 cup	oatmeal	4.8
1	apple	3.6
12	almonds	2
1/2 cup	chickpeas	6
1/2 cup	bulgur	4.2
1/2 cup	cucumber	1
1/2 cup	tomato	1.6
1/2 cup	broccoli	1.2
1/4 cup	sunflower seeds	3
1 cup	kale	5.72
1/2 cup	avocado	4.65
Total Fiber:		37.77
Example 3:
1	sweet potato	6.6
1/2 cup	black beans	7.5
1/2	avocado, small	4.65
1 cup	cabbage	2.2
1	apple, small	3.6
7	walnuts	1.9
1 cup	kale	5.72
8	pecans	2.7
1 cup	strawberries	3
Total Fiber:		37.87

Women’s Daily Recommended Intake: 21-25g per day

In a single day, you could eat the foods below to meet the daily recommended (fiber) intake.

Note: Additional foods would most likely need to be added to meet protein DRI or daily caloric requirements. These examples are simply highlighting fiber requirements irrespective of other nutrient requirements.

Example 1:
Qty	Food	Fiber (in grams)
2	corn tortillas	2
1/2 cup	pinto beans	7.5
1/2	avocado, small	4.65
1/2 cup	lentils	8
1/2 cup	brown rice	1.75
1/2 cup	green beans	1.95
Total Fiber:		25.85
Example 2:
1/2 cup	oatmeal	4.8
1	apple	3.6
12	almonds	2
1/2 cup	chickpeas	6
1/4 cup	bulgur	2
1/2 cup	cucumber	1
1/2 cup	tomato	1.6
1/2 cup	broccoli	1.2
1/4 cup	sunflower seeds	3
Total Fiber:		25.2
Example 3:
1	sweet potato	6.6
1/2 cup	black beans	7.5
1/2	avocado, small	4.65
1 cup	cabbage	2.2
1	apple, small	3.6
7	walnuts	1.9
Total Fiber:		26.45

Recipes that include High Fiber Ingredients:

Click the link below to view the recipe.

Note: This article is simply informative. This is not to be considered medical advice. Please discuss appropriate actions with your physician.