Consumers Turn to Food to Lower LDL Cholesterol

Many people are turning to foods before they try drugs to lower their LDL cholesterol, and the food industry is well-armed to respond.

By Mark Anthony, Ph.D., Technical Editor

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Cholesterol serves multiple important purposes. It's the precursor to steroid hormones and vitamin D; it helps form the bile acids that aid fat digestion; and it stabilizes membranes. But in the wrong place at the wrong time for some of us, cholesterol can earn its bad reputation.

The so-called "bad" cholesterol is that fraction transported from liver to tissues via low-density proteins (LDLs). Lipoproteins are particles that encapsulate fatty material and transport it through the blood. High-density lipoproteins (HDLs) move cholesterol in the opposite direction, from tissues to liver, a task that earns these smaller particles their "good cholesterol" nickname.

LDL cholesterol is thought to put us at risk for heart disease, via the participation of cholesterol in atherosclerotic plaque, while HDLs are believed to mitigate the risk. Since cardiovascular disease is still the No. 1 cause of death globally, manipulating cholesterol numbers -- lowering the former and raising the latter -- has become the quintessential dietary health strategy.

Proven to help reduce cholesterol” is such a powerful marketing message, Minute Maid says it twice. That’s also how many times a day you should drink the orange juice.
Proven to help reduce cholesterol" is such a powerful marketing message, Minute Maid says it twice. That's also how many times a day you should drink the orange juice.

Though heredity is an important determinant in LDL and HDL levels, diet can be the first line of defense against hypercholesterolemia. Eating cholesterol-laden foods has less of an effect on serum cholesterol than previously believed -- even the most stringent avoidance diet can be hard-put to drop cholesterol levels more than 20 percent. However, eating the tools -- the right foods and ingredients -- to lower cholesterol is where diet is important.

Start the day right

Few breakfast foods are as traditional as oats, which made Quaker Oats a household name long before cholesterol was a hot topic. When research on health benefits of soluble fiber first broke in the 1970s, oats were the grain most nutrition experts pointed to as a way to help lower cholesterol. But at the time few cold cereals were low-sugar, healthful sources of fiber.

"Smart Start Healthy Heart is the first national cold cereal containing the oat bran that may help lower cholesterol," says Zack Madden, account coordinator for Kellogg's (www.kelloggs.com), Battle Creek, Mich. Smart Start Healthy Heart is available in Original, Cinnamon Raisin and Maple Brown Sugar flavors. The cereal contains 2g soluble fiber from oat bran per serving. Three grams of soluble fiber daily from oat bran in a diet low in saturated fat and cholesterol may reduce the risk of heart disease.

An old breakfast food got a new lease on life with the 1997 FDA health claim: “Three grams of soluble fiber daily from oat bran in a diet low in saturated fat and cholesterol may reduce the risk of heart disease.
An old breakfast food got a new lease on life with the 1997 FDA health claim: "Three grams of soluble fiber daily from oat bran in a diet low in saturated fat and cholesterol may reduce the risk of heart disease.

Nature's Path Organic Foods (www.naturespath.com), Richmond, British Columbia, added SmartBran to its EnviroKidz, LifeStream and Optimum cereal line-up. "SmartBran is a natural extension," explains founder and CEO Arran Stephens. "SmartBran is the best source of heart-healthy, gut-healthy soluble fiber out there -- bar none," he claims.

SmartBran is the first certified-organic, high-fiber cereal with psyllium. It features three different sources of dietary fiber: psyllium, oat and wheat, totaling 13g of dietary fiber per serving.

Soluble fiber comes in many guises. Inulin is a unique form that consists of linked fructose sugars. Untouched by our digestive enzymes, inulin becomes food for friendly gut bacteria. "Historically, humans have eaten significantly large amounts of inulin. The highest food concentrations occur in dahlia tubers, burdock roots, chicory roots, artichokes and greens -- foods not traditionally eaten in large amounts these days.

The addition of inulin can provide soluble fiber in unexpected places. "Yogurt is a traditional source of probiotics, but with the addition of inulin, yogurt adds prebiotics to the mix and the potential for lowering blood cholesterol," says Carmelle Druchniak, senior communications manager for Stonyfield Farm (www.stonyfield.com), Londonderry, N.H.

Kellogg claims Smart Start Healthy Heart was the first national cold cereal containing the oat bran that may help lower cholesterol.
Kellogg claims Smart Start Healthy Heart was the first national cold cereal containing the oat bran that may help lower cholesterol.

Stonyfield obtains inulin in powder form from Orafti Group (www.orafti.com), Malvern, Pa., which derives inulin from chicory root via a natural, hot-water distilling process.

Because inulin is a soluble fiber, it helps maintain normal bowel function, decreases constipation, lowers cholesterol and triglycerides and helps normalize blood sugar levels. Inulin has been used as both a fat substitute and a sugar substitute. "Its slightly sweet taste and smooth texture improves the eating experience of low-fat and fat-free foods," says Druchniak.

"Research is demonstrating the nutritional value of inulin goes beyond what is typical of most classical fibers. Inulin has been shown to increase calcium absorption in adolescents and post-menopausal women by as much as 20 percent. As a prebiotic, inulin increases the growth of probiotics in the large intestine. This essentially adds a new site for calcium absorption," adds Druchniak.

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Already a source of probiotics, Stonyfield yogurt adds prebiotics and the cholesterol-lowering power of the soluble fiber in inulin.
Already a source of probiotics, Stonyfield yogurt adds prebiotics and the cholesterol-lowering power of the soluble fiber in inulin.

Some fats lower cholesterol

Most people with elevated cholesterol have been warned by their doctors to avoid eating saturated fats, which tend to raise LDL cholesterol levels. However, monounsaturated fats, like those in almonds, hazelnuts, walnuts, olives and avocados, both lower LDL cholesterol and raise HDL cholesterol.

Walnuts are rich in polyunsaturated fatty acids, which also have long been known to lower cholesterol. Yet many consumers still associate all fats, even healthy fats, with obesity, high blood cholesterol and cardiovascular disease. Although healthy fats are finally getting the recognition they deserve as beneficial foods, their value in lowering blood cholesterol is not always appreciated.

Too many consumers are unaware cholesterol is found only in animal products. While healthy plant oils contain no cholesterol, they do carry the plant counterpart, plant sterols, aka phytosterols. Plant sterols are structurally similar to cholesterol and interfere with its absorption from diet. Sterols for food and beverage formulations are derived from plants such as soy and corn. They appear as "free" sterols, the basic form of the ingredient, and sterol esters, that is, esterified to improve their solubility in oil.

"Conclusions from dozens of clinical studies conducted over the past 50 years show no significant difference in efficacy between the forms," says Pam Stauffer, marketing programs manager for Cargill Health & Food Technologies (www.cargill.com), Minneapolis. "This is corroborated by the FDA's approval of the unqualified health claim for both sterols and sterol esters."

Plant sterols shun water, and so were first incorporated into fat-based applications such as margarines and spreads. Cargill uses a propriety processing technology to enable its CoroWise plant sterols to be incorporated into many other types of food and beverages.

Note to marketers

From soluble fibers to whole grains to products containing phytosterols, it has never been easier to create foods that fit into a healthy, cholesterol-managing lifestyle. By utilizing ingredients tailored for products that naturally help maintain healthy cholesterol levels, food companies can take advantage of the many FDA-permitted health claims on labels and in marketing materials for a newly expanded range of food products.

"The market for plant-sterol containing products continues to grow," adds Stauffer. "Minute Maid Heart Wise orange juice with CoroWise was introduced in fall 2003. Since then, many other products have been introduced, including Nature Valley Healthy Heart chewy granola bars, VitaTops Vitamuffins, Rice Dream Heartwise rice drink, Lifetime low-fat cheese, GNC Heart Advance. One of the benefits for our customers is CoroWise does not negatively impact the taste and texture of the finished product."

Sterols spring up

The National Institute of Health (NIH), through the National Cholesterol Education Program, suggests Americans should consider plant sterols as a therapeutic lifestyle change for reducing cholesterol. And a 2003 review published in Mayo Clinic Proceedings states that eating foods low in saturated fat and cholesterol, and high in sterols, could reduce LDL cholesterol by 20 percent.

"The scientific evidence supporting the ability of plant sterols to lower serum cholesterol levels is reflected by the FDA heath claim -- which is an unqualified health claim more simply known as an 'A' level health claim," says, Brent Flickinger, senior research manager of nutritional science for ADM (www.admworld.com), Decatur, Ill. ADM's CardioAid plant sterols provide "effective, dietary method for countering elevated cholesterol."

In January this year, the FDA greatly expanded the GRAS categories for CardioAid plant sterols. "Until today, the range of food products which could be fortified under GRAS status with plant sterols was very narrow," said Steven Furcich, president of ADM Natural Health & Nutrition. "However, ADM's letter from the FDA now allows food companies to incorporate CardioAid brand sterols into many of their other consumer products. No other sterol ingredient available today has been evaluated for so many new GRAS food categories," he claims.

According to Graham Keen, ADM's vice president for corporate marketing, food companies now can incorporate CardioAid into mayonnaise, dressings, sauces, cereals, vegetable oils, beverages, salty snacks and processed soups.

Aristo bars add plant sterols to combat serum cholesterol, as well as cholesterol-managing ingredients omega-3 fatty acids and fiber.
Aristo bars add plant sterols to combat serum cholesterol, as well as cholesterol-managing ingredients omega-3 fatty acids and fiber.

Another unique application of plant sterols is their use as an addition in meal replacement/energy bars. "Our wellness bars offer the desired amount of sterols per serving required by the FDA to make the official Heart Health claim," says Gursh Bindra, CEO of Aristo Health Inc. (www.aristohealth.com), Morristown, N.J. Aristo bars also are rich sources of omega-3 fatty acids and fiber, other cholesterol-managing ingredients, as well as antioxidant-rich superfruits, such as açai, pomegranate, cranberry and goji.

Dairy pitches in

Other foods that can use plant sterols include dairy and similar products, such as puddings, soymilk, ice cream, cream, cream substitutes, yogurt and cheese.

We rarely think of drinking milk as a way to lower cholesterol, but the folks at Promised Land Dairy (www.promisedlanddairy.com) do. "Your Ultimate Milk" is the result of their vision. "These products came about as we studied a variety of health issues and ingredient opportunities to lend a hand toward increased health," says Rodger Johnson, spokesman for the San Antonio-based company.

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"We chose this avenue since it was unique to the fluid dairy category and would help those individuals who are avoiding the healthy aspects of dairy -- calcium, protein, and other nutrients -- for fear of increasing their cholesterol," Johnson adds. "We were able to do so with great flavor and lower fat."

The versatile soybean, a natural source of plant sterols, can be a valuable aid to lowering cholesterol as a source of both sterols and fiber. A 2003 report in the Journal of the American Medical Assn. states, "To enhance the effectiveness of diet in lowering cholesterol ... emphasize diets low in saturated fat, together with plant sterols and viscous fibers, and the American Heart Assn. supports the use of soy protein and nuts."

Multiple studies suggest consumption of soy foods can lead to better health. The U.K.'s Joint Health Claims Initiative declares 25g of soy protein daily, as part of a diet low in saturated fat can help reduce blood cholesterol. "Health authorities in many countries, including Brazil, Japan, Korea and the Philippines, have approved claims linking the consumption of soy with improved cardiovascular health," says Tom Woodward, vice president of sales and marketing for Devansoy Inc. (www.devansoy.com), Carroll, Iowa.

"It's obvious that with so many positive links between soy and health, consumers are really beginning to understand the potential benefits," he continues. "In addition, brands are leveraging this trend and developing products and promotions that address the ties between soy and cardiovascular health."

The maintenance of healthy cholesterol levels can fit neatly into nearly any lifestyle, and match virtually any taste. Reducing the risk of cardiovascular diseases with diet can be as simple as breaking old habits, both on the side of consumers and manufacturers.

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