October is National Cholesterol Awareness Month, but most people think they already know about cholesterol. Ask them, and they'll tell you it's bad, you should avoid it in your diet and that you want your blood cholesterol number to be lower.
Actually those three things are only about half true.
Your body makes cholesterol on its own. Good thing, because it serves some useful purposes in the body: cell structure, nerve function and so forth. Secondly, unless you eat no animal products whatsoever, you can't avoid it in your diet. And third, you really only want to lower the bad cholesterol -- the LDL stuff. HDL cholesterol, the good kind, is OK at higher levels.
Since the advent of statin drugs, most people don't worry very much about their cholesterol levels. The drugs are very effective at lowering bad cholesterol (the LDL stuff) and while that's good, some people feel they have a pass to return to eating a crappy diet. But these drugs aren't without their side effects, like short term memory problems, muscle weakness and others.
Head for the Pantry, Not the Medicine Cabinet
Did you know there are foods that will absolutely help lower cholesterol? But by how much? It depends on how much of them you eat. Foods like oatmeal, soy protein, almonds and plant sterols (think those special margarine-type spreads), along with fruits and vegetables each lower serum cholesterol a bit -- several percentage points. That's fine, but if you include them all together, there seems to be an additive effect.
Research by David Jenkins of the University of Toronto documented this effect, referring to it as the "Portfolio Diet." The additive effect amounts to a lowering of serum cholesterol by 30 percent, about the same as the early statin drugs. Of course, the down side is that this is a vegan diet -- no animal foods at all -- and that's hard for most of us.
Bean Counters Reap the Profits
If you'd rather get some serious cholesterol lowering without having to go completely vegan, there is hope on the way -- and you'll like this news.
The U.S. Dietary Guidelines for Americans recommends that people eat about three cups of beans per week, or about one-half cup daily -- not green beans, but the grown-up kind. Most people are lucky to eat a third of this amount, so there's room for improvement.
Some recent research from Donna Winham at Arizona State University indicates that just that recommended amount of beans -- one-half cup daily -- lowered cholesterol by about 8 percent, which lowers heart disease risk by 16 percent. She and her colleagues looked at pintos, black-eyes and carrots, with pinto beans coming out the winner for lowering cholesterol. Didn't matter how you ate them, just one-half cup daily (what we should be eating anyway) did the trick. And even better news is that most of the reduction was from the bad (LDL) cholesterol.
Picture it: If everyone in America followed the U.S. Dietary Guidelines and ate their one-half cup of pinto beans daily, you have to wonder how many people could get off of statin drugs (and be done with their side effects), or have fewer heart problems, reduced hospital stays and on and on.
Statin drugs are expensive. Beans are not -- they're so cheap it's almost ridiculous. That may be what keeps people from eating them.
For years beans have suffered the reputation as the poor man's meat. You ate beans if you couldn't afford to eat more expensive food or to stretch the meat you had. America needs to get over it and eat more beans, for crying out loud.
Beans are actually a vegetable, but they're high enough in protein that the government also considers them a meat substitute. Since they fit into two food groups, they're often lost in the shuffle. Given what beans have to offer us, they're probably the most neglected food in our diets, and they deserve better.
OK, let's just get it out in the open right now. You can't talk about beans without hearing jokes about flatulence and the ever popular campfire scene from "Blazing Saddles." The truth is, when you eat beans only occasionally (like for the Labor Day picnic and then once for the Super Bowl party) you eat a lot of them at once. Your body overdoses, and the results turn you off to beans for a while.
If you include them gradually and regularly, your body will adjust fine. And remember, half a cup does the trick, but you can start even smaller by just garnishing a salad with a spoonful and build from there. And one-half cup has about 6 to 8 grams of fiber, nearly a third of what you need for a whole day. Beans even help diabetics control their blood sugar and they're even fat-free.
What You Can Do
If you don't know your cholesterol level, find out. It's good to get a baseline level, so you know if things change over time. Whether your numbers are good or if they need some improvement, consider some simple dietary changes.
Here are some tips to get you started lowering your cholesterol without going near a pharmacy:
Take the pinto out for a spin. I'd like to see beans, including pintos, become a standard ingredient in salads and soups. They work in pasta sauce, too.
Beans are vegetables, so it's OK to substitute them for other veggies. If anyone balks at eating too many leafy greens, they'll probably go for beans, and it's mission accomplished.
Use canned beans to save time. If you're watching your salt intake, just rinse them well -- you'll lose 40 percent of the sodium.
Trade your chips and pretzels for almonds. Just an ounce or a small handful (about 23 almonds if you want to get technical), can lower cholesterol another 5 percent.
Try foods with added plant sterols. If margarine-type spreads aren't your thing, there are great small-shot drinks available instead. A typical portion is only 3 ounces -- good for those on-the-go, and one drink a day can lower you cholesterol another 7 percent.
Eat some soy -- burgers, tofu, edamame -- you choose, but do it. Try it at least once or twice a week.
Do each of these, and your cholesterol will come down about 20 percent, maybe more if it's really elevated. But whatever you do is better than nothing, so do something.
What Not to Do
Finally, you don't need to stop eating eggs. Yes they have cholesterol, but the cholesterol in your diet isn't much of an issue. Saturated fat is what really can raise your serum cholesterol, and eggs are low in saturated fat.
Read that last sentence again and please commit it to memory. There isn't a week that goes by that I don't get the egg question. Thank you in advance.
Keith-Thomas Ayoob is an associate professor in the department of pediatrics at the Albert Einstein College of Medicine in New York City.