Phytosterols: The Cholesterol Picker Upper

By David Grotto, RDN, LDN
As seen on Real Life Nutrition on WebMD

Phytosterols are a plant’s version of cholesterol; however instead of clogging up our arteries, they clean them! Phytosterols promote the movement of cholesterol into the intestinal tract and help block the absorption sites responsible for attracting cholesterol. Think of it like a game of musical chairs. If there are only 10 seats for 10 cholesterol bodies, then all of them will get a seat. But if you add in an additional 10 bodies of phytosterols, odds are that the seats will be divided evenly between cholesterol and phytosterols allowing for the remaining cholesterol to be whisked away.

There are two basic types of phytosterols: plant sterols and stanols. Despite their different names, research indicates that there are no significant differences in their health impact on cholesterol when consumed as part of a low-fat diet. The US Food and Drug Administration (FDA) approved a health claim for plant sterol/stanol esters for reducing the risk of heart disease: “Diets low in saturated fat and cholesterol that include at least 1.3 grams of plant sterol esters or 3.4 grams of plant stanol esters, consumed in two meals with other foods, may reduce the risk of heart disease.”

What Foods Contain Phytosterols?
In general, plant phytosterols are abundant in nuts, seeds, legumes and in plant oils. The richest sources are as follows:

Rice Bran Oil: 322mg/ounce: It has a mild nutty flavor and is a great oil to cook with because it has such a high smoke and is more resistant to oxidation giving it a nice long shelf life. It is an excellent source of vitamin E and contains an antioxidant called gamma-oryzanol, which has been thought to help lower one’s risk for heart disease. In one Japanese study, rice bran oil helped reduce symptoms of hot flashes among women subjects.

Corn oil: 264mg/ounce: Corn oil is one of the most popular cooking oils in the United States, especially in commercial cooking and baking. A double blind placebo controlled human study put men on either a diet containing 30% fat mainly from corn oil or from a sunflower/olive oil blend. Researchers found that the vitamin E content of corn oil did a better job of protecting the DNA of cells from mutating into dangerous cancer cells compared to a diet with sunflower and olive oil.

Sesame seeds/oil: 200-223mg /ounce. Cold-pressed sesame oil is great for deep frying because of its high smoke-point, whereas the dark brown oil is better suited for stir frying or sauces and dressings. Sesame seeds and their oil may have other heart health benefits beyond their phytosterol content. In a small study of hypertensive men who were placed on a daily regimen of a little over an ounce of sesame oil, it was observed that they had better blood flow through their arteries. This was the first study to show that daily intake of sesame oil improves endothelial function and this effect is sustained with long-term daily use.

Canola oil: 188mg/ounce: Canola oil is made from canola seed which belongs to the Brassica family where you’ll find members like cabbage and cauliflower. It contains the lowest level of saturated fats of any vegetable oil and is an excellent source of monounsaturated fatty acids and omega 3 fats, which benefit healthy cholesterol levels. Like corn oil, canola is also a rich source of vitamin E.

Sunflower seeds: 150mg/1/4 cup: Sunflower seeds are an excellent source of magnesium, copper, manganese, selenium, thiamine, and a Vitamin E (almost half of your daily requirements!). These nutrient packed seeds are also a good source of the B vitamins and other trace minerals, not to mention that they are also a great source of protein and fiber. The major phytosterol in sunflower seeds is beta-sitosterol which may benefit prostate and heart health.

Pistachios: 80mg/ounce: Pistachios are one of the oldest nuts in existence and it is estimated that humans have been eating pistachios in one form or another for at least 9,000 years. They are rich in the plant nutrients lutein, beta-carotene and contain a hefty amount of the gamma-tocopherol form of vitamin E. A randomized cross-over controlled Penn State study found that a couple of handfuls of pistachios a day added to a low cholesterol diet lowered LDL cholesterol and boosted heart-healthy antioxidants better than a heart healthy diet alone.

Wheat germ oil: 150mg/ounce: Wheat germ is the oily component of the wheat kernel. The oil contains high amounts of octacosanol, a plant nutrient found in vegetable oils that has been reported to enhance endurance, reaction time, and exercise capacity by increasing oxygen in cells of the body. It has also been associated with reducing cholesterol. A one- tablespoon serving supplies over 100% of the daily value of vitamin E. Wheat germ oil has also been used to treat various skin conditions such as eczema and skin rashes with some success.

Supplement it? Intakes of plant phytosterols/stanols in excess of the recommended 2g/day dose are associated with additional reductions in harmful LDL cholesterol, which may reduce the risk of coronary heart disease (CHD). The National Cholesterol Education Program recommends adding 2 grams daily of phytosterols to a cholesterol-lowering diet for people who have not been successful in lowering cholesterol by diet alone. In order to achieve this level, fortification of foods such as margarine-type spreads, orange juice, yogurt and yogurt-based drinks and dietary supplements might be necessary, even in addition to the plant sterol-rich foods mentioned above. A 5-week double blinded placebo controlled study demonstrated nearly a 5 percent reduction in “bad” low-density lipoprotein (LDL) cholesterol in participants who had elevated cholesterol levels when a supplement containing approximately 2 grams of plant phytosterols was added to their cholesterol reducing diet.

Cholesterol Smack-down Superheroes: Oats & Mushrooms !

Photo courtesy of the Mushroom Council
By David Grotto, RD, LDN, author of The Best Things You Can Eat

Seems like these two food staples are an unlikely pair, at least from a culinary standpoint. But I think you’ll find the Mushroom Ris-oat-o recipe at the end of this post proof positive that they make a tasty duo. And when it comes to health, this food pairing is no slouch when it comes to delivering more than just great taste – mushrooms and oats may be the ideal food crime fighter-combo for a healthy heart.

Bad cholesterol is a weighty issue. It is estimated that 20% of all strokes and up to 50% of heart attacks may be linked to high cholesterol. Family history, smoking, inactivity and even hormonal changes can all lead to elevated cholesterol. A growing and more common reason though is being over weight – especially when that weight collects around the midsection. Oats and mushrooms added to the diet may help combat hunger and give a feeling of fullness, which can help one manage their weight better.

Getting Mushy. Animal research has demonstrated that a diet containing mushrooms helps reduce total cholesterol, triglycerides, and harmful LDL-cholesterol. Several studies also have shown that mushrooms can reduce homocysteine, blood pressure, and can reduce oxidative and inflammatory damage to arteries, making them less susceptible to artery-clogging plaque. The antioxidant component of mushrooms that keep arteries healthy are largely attributed to their polyphenols– especially a substance called ergothionene, which may possess anticancer properties, as well. Mushrooms are naturally low in fat and calories and don’t contain cholesterol making them an ideal swap out for fatty meats or as a healthy extender for burgers, meatloaf, taco meat and casseroles.

Oatmeal Deal. Oats have hunger-busting qualities that can help aid in weight management. And like mushrooms, oats contain beta glucans that do a terrific job on sucking up cholesterol. There are over forty clinical studies spanning over forty years that confirm oats ability to not only lower total cholesterol but also harmful LDL cholesterol. Why? Oats contain additional heart healthy antioxidant nutrients such as vitamin E and avenanthramides along with soluble and insoluble fiber that makes it quite difficult for cholesterol to hang around. Eating three grams of soluble fiber from oats, each day, along with a low fat and cholesterol diet, has been shown to lower blood cholesterol and harmful low-density lipoproteins (LDLs). Research shows that eating a fiber-rich diet and a nutritious breakfast can help you maintain a healthy weight.

Including foods such and mushrooms and oats as part of a low saturated fat, high fiber diet, is a heart-smart thing to do. Try combining them both into this tasty Mushroom Ris-oat-o side dish!

Wild Mushroom Ris-Oat-To (as featured in 101 Optimal Life Foods)

Servings: 6

Base Ingredients:

1 ½ cups of water

2 cans low-sodium chicken broth

1 cup of yellow onions, diced

2 garlic cloves, minced

2 cups Oats, Old Fashioned

1 cup of dry white wine

1 cup grated fresh Parmigiano-Reggiano cheese

Sea salt & cracked black pepper to taste

Directions:

To prepare Ris-Oat-To, in a sauce pan bring 1 ½ cups of water and broth to a simmer. Keep warm over medium heat.

Heat a medium sauté pan over medium-high heat. Coat pan with a drizzle of olive oil. Add onion and garlic, sauté about two minutes until golden brown.

Add oats and toast until golden brown, stirring constantly.

Add wine, cook for a minute or until liquid is nearly absorbed, stirring constantly.

Stir in 1 cup of broth mixture, cook for four minutes or until liquid is nearly absorbed, stirring constantly.

Add remaining broth mixture, ½ cup at a time, stirring constantly until each portion of broth is absorbed before adding the next

Remove Ris-Oat-To from the heat and add in ½ cup of cheese

Season with sea salt and black pepper to taste.

Mushroom Mixture

Ingredients:

4 cups of sliced mushrooms of your choice

2 tablespoons of olive oil

1 tablespoon of freshly chopped thyme

½ teaspoon sea salt

½ teaspoon cracked black pepper

Directions:
Heat olive oil in a large non stick pan over medium high heat, add mushrooms and crushed garlic clove and sauté for about 4 minutes until golden brown and crispy. At the last second season with salt and pepper and fresh thyme.

Spoon Ris-Oat-To into 6 medium size bowls and top with crispy mushrooms, and a pinch of cheese.

Nutrition Profile

290 Calories, 12g Total Fat, 4g Sat Fat, 15mg Cholesterol, 320mg Sodium, 26g Carbs, 4g Fiber, 13g Protein

Disclosure. I am a spokesperson for the Mushroom Council.

Take Heart: This is One ER Doc You Don’t Want to See (except on television)

 

 

 

 

 

As featured today on WebMD Real Life Nutrition

By David Grotto, RD

Wow! That Giants – Patriots game last night sure was enough to make your heart skip a beat, eh?! Patriots fans may have felt a twinge in their chest at the end of the 4th quarter with that disappointing loss. And believe it or not, getting caught up in the excitement of an action-packed Super Bowl game might be enough to land you in the emergency room!

Doctors in the ER see their fair share of chest discomfort come through their doors. According to the Centers for Disease Control, every year about 785,000 Americans have a first heart attack. Many don’t even know they are having one, and depending on where in the heart the attack occurs, some won’t live to experience a second one. Heart disease is the number one killer of both men and women, accounting for nearly 600,000 deaths in the U.S. in 2009, according to the CDC, with an estimated declining figure for 2010 of 400,000 deaths, according to the World Health Organization. Slightly more than half of those deaths occur in men. And unfortunately, women are closing that gap.

Many women wouldn’t mind seeing the doc I interviewed for this post in the ER. You may know him from his appearance on The Bachelor or as “Dr. Travis” from the award-winning talk show, The Doctors. He doesn’t just play a doctor on TV – he actually is a highly trained emergency room doctor by profession. Dr. Travis Stork, MD graduated Magna Cum Laude from Duke University and earned his MD with honors from the University of Virginia. He works as an emergency room doctor and brings his real life experiences to the show he co-hosts and to his bestselling books: The Lean Belly Prescription and The Doctor Is In: A 7-Step Prescription for Optimal Wellness. But Dr. Stork would prefer never to see his fans in the ER. “You can’t reverse the effects of dead heart muscle once you’ve had a heart attack,” he says. “So don’t wait until you have one to start following a healthy lifestyle. You don’t want to come to the ER and hear me say ‘it’s too late.’” So with an eye on prevention, I asked Dr. Travis Stork to share his thoughts on our current battle against heart disease and his best advice on how to avoid ever seeing him in the ER.

Are we making any progress in the war against heart disease?

Dr. Stork. The numbers are still alarming. It’s still the #1 killer of both men and women. Death rates are declining, which is good, so yes, we are making headway. But in some respects, we are doing worse. We’ve made advances in diagnosis. [Many] women most likely died of heart disease years ago but we might have thought it was from something else because we didn’t think of heart disease as a “woman’s disease”. In the last decade or so, there has been a new focus on women and heart disease and more progress is being made. But time is so limited with your doctor, so conversation is also limited and heart disease messages don’t always get out there. Media is doing a better job and I think our show is getting the word out. However, I’m concerned that if we don’t reverse our current obesity trend, it won’t matter how great our technology is — we won’t make the headway needed to continue to curb heart disease.

Let’s start with the doctor-patient relationship. What can be done to foster better communications there?

Dr. Stork. Feel empowered. Talk with your doctor about steps to improve your health. Ask him/her, “What are the steps I can take?” So much education has to take place outside of the doc’s office – there’s simply not enough time during a visit to cover everything. Knowledge is power. When you visit your doctor to discuss treatment strategies, bring information with you so he/she can tailor a program more to your needs. The doc will know where you’re coming from and can better gage your motivation to make lifestyle changes. What lab tests/technologies are the best indicators that we are at risk for heart disease? Dr. Stork. Cholesterol is a good baseline test. Just like what leads to glucose and blood pressure problems, heart disease starts early in life. Your cholesterol may be perfect at age 20 — at least you know where you are at, if you have it tested. If it is elevated, you need to take extra precautions. Having your blood pressure, glucose, and cholesterol tests done as recommended are the best ways to get a snapshot of your health and they are fairly cheap to have performed. Know your numbers! For example, 64 slice CT scans are often advertised to detect heart disease, but most insurance companies don’t pay for them. Why? Is it worth the out-of-pocket investment? Are they accurate? We have more and more tech that can detect heart disease earlier. But whether the CT scan shows or doesn’t show disease, you should live every day to maximize heart health regardless of the results. Why would you want to wait until you have a problem to act?

What dietary and lifestyle advice do you recommend for your patients and fans?

Dr. Stork. Be wary of some new food that gets positive press — the #1 food that is supposed to be the be all and end all when it comes to fighting heart or any other disease. Consumers tend to latch on to the next big headline. Our show checks out how valid the information is about a food or product before jumping on the bandwagon. People don’t need to get distracted by the headlines – keep it simple. Soluble fiber from oats can lower cholesterol. Ordering salads without the creamy dressings and instead using olive oil and vinegar is a simple thing to do. Don’t focus on can’t do, focus on can dos. I ride my bike to work every day, rain or shine. It’s important to do physical activity that you enjoy doing. I feel when we talk about physical activity in a clinical setting, it sounds so boring. Getting active can be as simple as just getting on your feet more and not about going to the gym more. Getting on your feet doesn’t have to be one of the things you hate. In fact, it can reduce C-reactive protein (a marker for inflammation). Try getting on your feet when you’re on the phone. Most say, “I can do that!” Those are the kinds of messages that people relate to – 30 more minutes of activity versus watching more TV. Try to view health as a hobby rather than something you dread. You will get more enjoyment out of life and have a more positive attitude.

Can you lower your cholesterol without drugs? Are their dietary supplements that you recommend for lowering cholesterol?

Dr. Stork. Be careful with dietary supplements. I believe that eating whole foods has the best benefit for your health. Beans, oats, nuts, olive oil in place of butter, and fatty fish are all heart-healthy foods. More docs are recommending Omega 3 supplements for helping to control triglycerides. My #1 advice: treat a supplement like you would a medicine and talk to your doc. Tell your doctor what you are taking so that it can be entered into the electronic medical record. That way he or she will know what supplements you are taking in addition to your meds and will have a better idea of what you are doing. There is a role for supplements but be cautious about how they are used.

We hear inflammation is tied to heart disease. What can we do to reduce inflammation?

Dr. Stork. Believe it or not, flossing your teeth everyday helps control inflammation and inflammation is connected to heart disease. Data on flossing and longevity is quite interesting – decreasing your bacterial load in your mouth is good for your gums and may be good for your heart. Eating fruits and veggies can also help reduce inflammation.

Are statins safe? Any concerns with them?

Dr. Stork. Meds are patient specific. Statins can raise liver enzymes and possibly cause myopathies. But they can be very effective in lowering cholesterol. I take a two-pronged approach – just popping a pill is the wrong mindset. Meds are important. No matter what some people do to take care of themselves, they may be predisposed to heart disease, so meds might be appropriate for them. Yes, there are docs who are “meds first” and there are docs that are “lifestyle first”. We are getting better and better at offering lifestyle but some are still just giving meds – it’s easier. We probably do, as a profession, lean too much on meds because of the grim stats. It is difficult for many patients to make the necessary lifestyle changes.

How often should you see your doctor?

Dr. Stork. See your doc annually and have your cholesterol checked annually as well. Seeing your doctor should be tailored to your needs. The good news is if you take good care of yourself, then you don’t need to go to the doc as much. View health care as a check-up. The better choices you make, the longer time you can go between checkups. For example, if your blood pressure is elevated, you might have to see doc more frequently to make sure it is under control.

Final thoughts?

Dr. Stork. My personal belief is all of us should live our lives as if we have heart disease. Don’t wait until you have a diagnosis or a bad lab value to make the necessary lifestyle changes to lower your risk. Diagnostic tools are great, but why wait? Assume you will have heart disease unless you make the right choices. Control the risk factors: Smoking, high blood pressure, high cholesterol, high triglycerides, untreated diabetes, obesity, stress, and lack of regular exercise. What’s interesting is there are really three simple things you need to do – get active, eat better, and stop smoking. Concentrating on these three risk factors leads to all the others.

Thanks to Travis Stork, MD for sharing his wonderful advice. Next week I’ll offer some of my own advice on the best foods for fighting heart disease along with some yummy recipes! Stay tuned and have a great week!