Cholesterol and heart disease: The role of diet Your diet clearly plays a role in determining your cholesterol levels, but if you're like most people, the most important factor isn't how much cholesterol-rich food you eat. Rather, it's what else you eat. Figuring this out has been a learning process. Get your copy of Managing Your Cholesterol   Managing Your Cholesterol offers up-to-date information to help you or a loved one keep cholesterol in check. The report spells out what are healthy and unhealthy cholesterol levels, and offers specific ways to keep cholesterol in line. It covers cholesterol tests and the genetics of cholesterol. The report also focuses on treatments based on the latest scientific evidence, including the pros and cons of statins and other medications, and provides the lowdown on other substances advertised to lower cholesterol. Managing Your Cholesterol can also help you work with your doctor to individualize your treatment. Initially, the news that cholesterol in the bloodstream was linked to heart disease prompted an all-out war on cholesterol in food. From the 1960s on, people were advised to stay away from foods rich in cholesterol, like eggs, dairy foods, and some types of seafood. But today, the science suggests that, for most people, dietary cholesterol (the cholesterol in foods) has only a modest effect on the amount of cholesterol in the bloodstream. In fact, the 2015–2020 Dietary Guidelines for Americans eliminated an earlier recommendation to limit dietary cholesterol to 300 milligrams (mg) per day—although they still suggest caution on overall intake. Notably, the guidelines did not change the recommendation on saturated fat, which is found mainly in animal-based foods such as meat and dairy—and is often found in high-cholesterol foods. Saturated fat in the diet clearly does raise LDL by a significant amount and should still be consumed in limited quantities. And although some research has cast doubt on the conventional wisdom that saturated fat is linked with heart disease, other research upholds the link. Foods high in fiber, low in saturated fat can lower cholesterol While saturated fat and dietary cholesterol both play a role in your cholesterol level, experts stress that the most important dietary change you can make to lower your cholesterol numbers is to adjust the overall pattern of your diet. Best is a diet rich in fruits, vegetables, fish, and whole grains. This helps in two ways. First, the more of these healthful foods you eat, the less you generally consume of foods that are high in saturated fat and highly refined carbohydrates, which both damage the cardiovascular system. Second, high-fiber foods help reduce your cholesterol level by making unhealthy dietary fats harder to absorb from the gut. This doesn't work for everyone, however. For people at high risk of heart disease, dietary efforts don't come close to lowering cholesterol enough. Other people are genetically predisposed to having high blood cholesterol regardless of what they eat. To learn more about cholesterol and heart disease, read Managing Your Cholesterol, a Special Health Report from Harvard Medical School. Image: © udra | Getty Images Share this story:

Grapefruit juice and statins Q: I've heard that people shouldn't drink grapefruit juice if they're taking a statin. Why? A: Certain classes of drugs — most notably statins — are metabolized (broken down) in your intestines by an enzyme called CYP3A, which normally reduces the amount of drug that enters your bloodstream. Grapefruit juice contains compounds called furanocoumarins that stop CYP3A from doing its job. As a result, more of the drug is absorbed, making it more powerful than it's meant to be — even toxic in some cases. Not all statins are affected equally by grapefruit juice, so grapefruit fans might want to switch to a statin that's less affected (see the table below). But if you can't switch, experts say it's probably okay to enjoy a small glass. That's because the studies showing dangerous effects used massive amounts of furanocoumarins, the amount found in a quart or more of the juice. What's more, eating half a grapefruit is even less risky than drinking grapefruit juice, since it takes several fruits to make a single glass of juice. But to be on the safe side, check with your doctor, and avoid taking your pills with grapefruit juice.  The grapefruit effect  Grapefruit juice affects certain statins more than others.  Big effect  Little or no effect  atorvastatin (Lipitor)  fluvastatin (Lescol)  lovastatin (Mevacor)  pitavastatin (Livalo)  simvastatin (Zocor)  pravastatin (Pravachol)    rosuvastatin (Crestor) To learn more about cholesterol and heart disease, read Managing Your Cholesterol, a Special Health Report from Harvard Medical School. Image: Wavebreakmedia, Ltd./Getty Images Share this story:

Featured in this issue

Managing Your Cholesterol Featured content: • Cholesterol: Good, bad, and indifferent • Cholesterol and heart disease • Understanding your cardiovascular risk • Why treat cholesterol? • Your cholesterol test • Making sense of the statin guidelines • Special Section: Lifestyle changes to improve your lipid levels Click here to read more »