Taking psyllium-based fiber supplements or beta glucan supplements (beta glucan is found in barley and oats) may also help lower LDL, particularly if you’re unable or unwilling to eat a lot of foods high in soluble fiber. But fiber supplements can cause gassiness, bloating, cramps, and diarrhea and may decrease the absorption of the fat-soluble vitamins A, D, E, and K. Also, some people may be allergic to psyllium, so caution is necessary; the incidence of psyllium allergy appears to be higher among health-care workers. Signs of psyllium allergy may include rash, itching, and shortness of breath.
Distant cousins to cholesterol (they share a similar chemical structure), phytosterols, or plant stanols and sterols, are natural substances found in plant cell membranes that compete with cholesterol for absorption in the intestinal tract. What this means is that if you consume enough of them, your total cholesterol and LDL cholesterol may decrease (but not if you eat a double cheeseburger with fries along with them). In fact, you can lower your LDL cholesterol by up to 15% by consuming at least 2 grams of phytosterols every day.
The evidence for phytosterols is strong enough for the National Cholesterol Education Program to have added the recommendation to consume at least 2 grams per day if one’s cholesterol is high. The Food and Drug Administration (FDA) also allows the following health claim on foods that meet the criteria:
“Foods containing at least 0.65 gram per serving of vegetable oil plant sterol esters, eaten twice a day with meals for a daily total intake of at least 1.3 grams, as part of a diet low in saturated fat and cholesterol, may reduce the risk of heart disease.”
Natural sources of plant stanols and sterols include fruits, vegetables, vegetable oils, nuts, legumes, and whole grains. However, it would be difficult to consume much more than 500 milligrams (mg) of phytosterols daily from these food sources.
Food manufacturers have also fortified a number of foods with phytosterols, including certain brands of vegetable oil spread, juice, yogurt, soy milk, rice milk, snack bars, and even chocolate. Over-the-counter phytosterol supplements are also available.
Plant stanols and sterols are quite safe: There are no known harmful side effects of consuming them, and they can be taken or eaten along with a statin or a fibrate for an even greater LDL reduction.
Back in the 1990’s, researchers thought that soy was another tool in the cholesterol-buster’s arsenal. At the time, a meta-analysis of 38 studies appeared to show that consuming at least 25 grams of soy protein daily could help lower total and LDL cholesterol and triglycerides.
But in 2006, a second look at the research cast doubt on the magnitude of soy’s benefit in this area. The American Heart Association announced that eating soy had much less of an effect on LDL than previously thought, lowering it only by about 3%. The other catch is that most Americans don’t eat that many soy foods on a daily basis, so few are likely to consume 25 grams of soy protein per day. However, the evidence of some benefit is still there, so if you’re willing to eat a few soy-based meals a week, soy may be of some help in lowering your LDL.
Soy protein is found in tofu, tempeh, miso, edamame (green soybeans), soy nuts, soy milk, soy cheese, and soy-based meat substitutes (such as veggie burgers, soy hotdogs, and “bacon” strips).
Soy foods are generally considered to be safe, but another component of soy, called isoflavones, are natural, estrogen-like substances that may reduce thyroid function in some people (although these findings are not consistent). Women who have had estrogen-sensitive breast cancer and are taking either a selective estrogen receptor modulator (such as tamoxifen [brand name Nolvadex], raloxifene [Evista], or toremifene [Fareston]) or an aromatase inhibitor (such as anastrozole [Arimidex], exemestane [Aromasin], or letrozole [Femara]) should probably not eat soy foods until treatment has been completed.