Atherosclerosis involves a buildup of plaque in the blood vessels. It can lead to complications like heart attack and stroke.
Screening for components contributing to atherosclerosis, such as cholesterol levels, is vital in preventing adverse cardiovascular outcomes.
A recent study found that testing for a specific protein, apolipoprotein B-100 (ApoB), may be a more accurate method of predicting atherosclerotic cardiovascular disease risk than testing for cholesterol levels alone.
The health of the heart and blood vessels is vital to body function. Early screening can help people understand their risks and potentially prevent adverse health outcomes.
Testing cholesterol levels is important, but another test can further help identify the risk for cardiovascular disease: apolipoprotein B-100 (ApoB) levels. This protein helps transport cholesterol throughout the body.
Testing for the level of this protein in the blood may help identify people who are more at risk for cardiovascular disease, even when cholesterol levels are normal.
AtherosclerosisTrusted Source is a condition characterized by the buildup of plaque in the walls of blood vessels. This plaque can be made of cholesterol and other substances.
Atherosclerosis makes it harder for blood to circulate properly in the body. It can lead to several health complications if left unchecked.
Cardiologist at the Texas Heart Institute, Dr. Salim ViraniTrusted Source, who was not involved in the study presented at ACC23, explained to Medical News Today that:
“Atherosclerosis is a buildup of fat, cholesterol, and other substances inside the artery walls. That buildup is referred to as plaque. Plaque ultimately causes the arteries to become narrow and eventually restricts blood flow. When the plaque bursts, it can lead to a blood clot — and, in turn, increase the chances for a stroke or heart attack. Atherosclerotic cardiovascular disease includes heart attacks, strokes, stents, bypass surgery or blockage of blood vessels supplying blood to the lower limbs or the brain.”
Because atherosclerotic cardiovascular disease can be deadly, early testing can help people identify and minimize their risk. One area of interest is testing cholesterol levelsTrusted Source.
High cholesterol levels, particularly low-density lipoprotein (LDL) cholesterol, can increase the risk for atherosclerosis and atherosclerotic cardiovascular disease.
Testing for cholesterol levels can be part of routine blood work. Still, another test, for ApoB, may help further identify the risk for poor heart health.
“ApoB, short for apolipoprotein B, is the main protein found in LDL particle which carries ‘bad’ cholesterol as well as other particles that carry bad forms of cholesterol. It moves fat throughout the body and helps it get through the walls of arteries, where it can form plaque,” Dr. Virani explained.
“When this happens, it increases [the] risk of heart disease and stroke. Measuring for ApoB is a direct measure of all the particles that could contribute to heart disease within your bloodstream,” he added.
The study presented at ACC23 examined trends in testing for ApoB and how levels of this protein relate to low-density lipoprotein (LDL) cholesterol levels.
The researchers used data from Intermountain Healthcare electronic medical records, looking at when people were tested for ApoB and LDL cholesterol levels. They examined data collected between 2010 and 2022 from 705 individuals whose average age was 56 years. Of the total number, 41% were female.
First, they found that the amount of testing for ApoB increased throughout this time frame. They also found that ApoB levels may still be elevated, even when LDL cholesterol levels are in a healthy range.
Among their participants, about 46% of them still had elevated ApoB levels, even when LDL cholesterol was less than 70 milligrams per deciliter (mg/dL), a concentration supposed to be in the healthy range.
“Apo-B provides unique information beyond LDL-C [bad cholesterol]. At low LDL-C levels, ApoB may still be elevated. Apo-B [according to] other studies is a better risk predictor than LDL-C, so if elevated, it may indicate small, dense LDL (i.e., cholesterol poor), [and] more aggressive Rx is indicated.”
In other words, when someone has an elevated ApoB level with a normal LDL cholesterol level, they can still be at risk for atherosclerotic cardiovascular disease and should be treated accordingly.
“These ‘small dense LDL’ particles are still atherogenic,” Dr. Anderson further elaborated. This means that they promote the formation of fat deposits in the arteries.
“The implication is that some patients with LDL [under] 70 — especially those with metabolic syndrome, pre-diabetes, or diabetes — may be undertreated,” said Dr. Anderson. “In them, check ApoB, and if ApoB is still elevated ([over] 60 for example), further intensification of lipid-lowering therapy – e.g. with statins or PCSK9 inhibitors — may be indicated.”
The study collected data from a limited number of participants from 24 hospitals and approximately 200 clinics in Utah, Idaho, and Nevada. Further studies analyzing larger datasets would be necessary to confirm the study’s findings.
Nevertheless, the current findings suggest that testing for ApoB may benefit people at risk for cardiovascular disease. This particular test is also becoming more common. Once doctors identify someone with elevated ApoB levels, they can create an appropriate treatment plan.
Dr. Virani explained the common steps after finding out that someone’s ApoB level is elevated:
“When high ApoB levels are detected, the initial first steps for treatment are the same as they would be for detection of high LDL cholesterol levels: dietary changes, such as eating foods low in saturated and trans fats and maintaining a healthy weight through diet and exercise. LDL cholesterol-lowering medications, such as statin therapy, are also often prescribed.”
Overall, the study notes that ApoB testing may be needed as another step to help detect risk for atherosclerotic cardiovascular disease.
Dr. Jayne Morgan, cardiologist, executive director of Health and Community Education at Piedmont Healthcare, and creator of the Stairwell Chronicles, not involved in this research noted to MNT that “[t]he continued presence of these small dense particles, even with LDL levels lowered to goal, supports the use of ApoB measurements to further direct heart health therapy and guidance between a physician and a patient.”
“Treating patients aggressively for both prevention and intervention of heart disease, especially with lower LDL levels, may incorporate ApoB levels as a common practice to further determine patients still at risk of cardiac events because of elevated atherogenic particles,” she added.
Saturated Fat and Cholesterol are Important Parts of a Healthy Diet
Saturated fat and cholesterol have been wrongfully vilified as the culprits of heart disease for more than six decades. Meanwhile, research has repeatedly identified refined carbs, sugar and trans fats found in processed foods as the real enemy.
The first scientific evidence linking trans fats to heart disease while exonerating saturated fats was published in 1957 by the late Fred Kummerow,1 biochemist and author of “Cholesterol Is Not the Culprit: A Guide to Preventing Heart Disease.” Unfortunately, Kummerow’s science was overshadowed by Ancel Keys’ Seven Countries Study,2,3 which linked saturated fat intake with heart disease. The rest, as they say, is history. Later reanalysis revealed cherry-picked data was responsible for creating Keys’ link, but by then the saturated fat myth was already firmly entrenched.
Keys’ biased research launched the low-fat myth and reshaped the food industry for decades to come. As saturated fat and cholesterol were shunned, the food industry switched to using sugar and trans fats (found in margarine, vegetable shortening and partially hydrogenated vegetable oils) instead.
The Big Fat Surprise
Investigative journalist Nina Teicholz was one of the first major investigative journalists to break the story on the dangers of trans fats in a 2004 Gourmet magazine article.4 In the video below, Joe Rogan interviews Teicholz on her 2014 book, “The Big Fat Surprise,” which grew out of that initial exposé.
In it, not only does she dismantle the belief that saturated fat and cholesterol make you fat and cause disease, she also reveals that while the dangers of trans fats are now becoming widely recognized, the recommended replacement — vegetable oils — may actually be even more harmful. She also delves into the politics and shady underbelly of nutritional science, revealing how the food industry has manipulated the scientific discussion and built a largely false foundation for the nutritional recommendations we’re given.
Corruption is not the sole problem, though. Teicholz notes there is a very strong tendency to “fall in love” with your own ideas and beliefs, and this is as true for scientists as it is for regular people. And, when you strongly believe something to be true, you will tend to find the evidence you’re looking for and ignore anything that refutes it. So, it’s really a human psychology problem.
Scientists are not supposed to fall into this all-too-human trap. “They’re taught to distrust their beliefs [and] shoot down their own hypothesis,” Teicholz says, “but in the case of nutrition science, that didn’t happen … They cherry-picked the evidence and completely ignored and actively suppressed, even, anything that contradicted their ideas.” This certainly included Keys, who was passionately wed to his hypothesis that saturated fat caused heart disease.
Busting the Low-Fat Myth
Teicholz points out the fact that saturated fat has been a healthy human staple for thousands of years, and how the low-fat craze has resulted in massive sugar consumption that has increased inflammation and disease.5 The American Heart Association (AHA) started encouraging Americans to limit dietary fat, particularly animal fats, to reduce their risk of heart disease in 1961, and maintains this position to this day.
Just last summer, the AHA sent out a presidential advisory to cardiologists around the world, reiterating its 1960s advice to replace butter and coconut oil with margarine and vegetable oils to protect against heart disease. Yet historical data clearly shows this strategy is not working, because concomitant with low-fat diets becoming the cultural norm, heart disease rates have soared. The AHA also ignores research demonstrating the low-fat, low-cholesterol strategy does more harm than good. For example:
In 2012, researchers at the Norwegian University of Science and Technology examined the health and lifestyle habits of more than 52,000 adults ages 20 to 74, concluding that lower cholesterol levels increase women’s risk for heart disease, cardiac arrest and stroke. Overall, women with “high cholesterol” (greater than 270 mg/dl) actually had a 28 percent lower mortality risk than women with “low cholesterol” (less than 183 mg/dl).6
In 2013, prominent London cardiologist Aseem Malhotra argued in the British Medical Journal that you should ignore advice to reduce your saturated fat intake, because it’s actually increasing your risk for obesity and heart disease.7
A 2014 meta-analysis published in the Annals of Internal Medicine, using data from nearly 80 studies and more than a half-million people, found those who consume higher amounts of saturated fat have no more heart disease than those who consume less. They also did not find less heart disease among those eating higher amounts of unsaturated fat, including both olive oil and corn oil.8,9
The following graph, from a British Journal of Nutrition study published in 2012, also shows how Europeans who eat the least saturated fats have the highest risk of heart disease, whereas those who eat the most have the lowest rates of heart disease — the complete opposite of conventional thinking and AHA claims.
Your Body Needs Saturated Fat and Cholesterol
Cholesterol is not only beneficial for your body, it’s absolutely vital for optimal functioning. For example, cholesterol is needed for the construction of your cell membranes and helps regulate the protein pathways required for cell signaling. Having insufficient amounts of cholesterol may negatively impact your brain health, hormone levels, heart disease risk and more.
Your body also needs saturated fats to function properly. One way to understand this need is to consider the foods ancient humans consumed. Many experts believe we evolved as hunter-gatherers and have eaten a variety of animal products for most of our existence on Earth. To suggest that saturated fats are suddenly harmful to us makes no sense, at least not from an evolutionary perspective.
Reducing saturated fat to extremely low levels, or shunning it altogether, also doesn’t make sense when you consider its health benefits and biological functions, which include but are not limited to:
Providing building blocks for cell membranes, hormones and hormone-like substances
Facilitating mineral absorption, such as calcium
Acting as carriers for fat-soluble vitamins A, D, E and K
Converting carotene into vitamin A
Helping to lower cholesterol levels (palmitic and stearic acids)
Antiviral activity (caprylic acid)
Optimal fuel for your brain
Providing satiety
Modulating genetic regulation and helping prevent cancer (butyric acid)
High-Carb Versus High-Fat Diets
As noted by Teicholz, by eliminating saturated fat and cholesterol-rich foods we’ve also eliminated many of the most nutrient-dense foods from our diet — eggs and liver being just two examples — and this also has its repercussions for human health and development. Vitamins A, D, E and K are fat-soluble, which means you need the fat that comes naturally in animal foods along with the vitamins in order to absorb those vitamins.
Additionally, fat is very satiating, so you’re far less likely to overeat on a high-fat diet than a high-carb diet. Most people who complain about “starving” all the time are likely just eating too many carbs (quick-burning fuel) and not enough fat (slow-burning fuel).
Then there’s carb-addiction, of course, which further fuels the cycle of hunger and overeating. What’s worse, when you eat a high-carb diet for a long time, it blocks or shuts down your body’s ability to burn fat, which means all of your body fat remains right where it is, as it cannot be accessed for fuel.
By shifting your diet from high-carb to high-fat, you eventually regain the metabolic flexibility to burn both types of fuel — fat and sugar — which solves most of these problems; the hunger and cycle of overeating, weight gain, inflammation and related disease processes. Cyclical ketogenic diets are very effective for this, as is intermittent fasting and longer water fasts for those who are overweight.
The Problem with Vegetable Oils
As mentioned earlier, Teicholz’s book also delves into a new nutritional twist that has developed as the dangers of trans fats have been exposed and accepted. While the U.S. Food and Drug Administration has removed partially hydrogenated oils — the primary source of trans fats — from the list of “generally recognized as safe” ingredients, the vegetable oils (such as canola, peanut, corn and soy oil) that have replaced them may have even more harmful health ramifications.
When heated, vegetable oils degrade into extremely toxic oxidation products. According to Teicholz, more than 100 dangerous oxidation products have been found in a single piece of chicken fried in vegetable oils. As early as the 1940s, animal experiments showed animals would develop cirrhosis of the liver or enlarged liver when fed vegetable oils. When fed heated vegetable oils, they died prematurely.
Cyclic aldehydes are among the most toxic of these byproducts, and animal research has shown even low levels of exposure cause serious inflammation, which is associated with heart disease and Alzheimer’s. Findings like these make the AHA’s recommendation to use margarine and vegetable oils all the more troubling.
In her book, Teicholz also cites research in which aldehydes were found to cause toxic shock in animals by damaging the gastrointestinal tract. We now know a lot more about the role your gut plays in your health, and the idea that aldehydes from heated vegetable oils can damage your gastric system is frighteningly consistent with the rise we see in immune problems and gastrointestinal-related diseases.
How a Cyclical Ketogenic Diet Can Improve Your Health
Two-thirds of the American population is overweight or obese,10 more than half of all Americans struggle with chronic illness,11 1 in 5 deaths in the U.S. is obesity-related12 and 1 in 4 deaths is related to heart disease.13 Saturated dietary fats and cholesterol are not to blame for these statistics. The evidence is actually quite clear: Excessive net carbohydrate intake is the primary culprit behind these disease statistics, primarily by decimating your mitochondrial function.
To address this, you need to eat a diet that allows your body to burn fat as its primary fuel rather than sugars, and to become an efficient fat burner, you actually have to eat fat. In my latest book, “Fat for Fuel,” I detail a cyclical or targeted ketogenic diet, which has been scientifically shown to optimize metabolic and mitochondrial health. A primary difference between this program and other ketogenic diets is the cyclical component.
It’s important to realize that the “metabolic magic” in the mitochondria occurs during the refeeding phase, not during the starvation phase. If you’re constantly in ketosis, you’re missing out on one of the most valuable benefits of the ketogenic diet. Basically, once you have established ketosis, you then cycle healthy carbs back in. As a general rule, I recommend adding 100 to 150 grams of carbs on the day or days each week that you do strength training. Some of the most important benefits of this kind of eating program are:
Weight loss
By rebalancing your body’s chemistry, weight loss and/or improved weight management becomes nearly effortless. Studies have shown a ketogenic diet can double the weight lost compared to a low-fat diet.14
Reduced inflammation
When burned for fuel, dietary fat releases far fewer reactive oxygen species and secondary free radicals than sugar. Ketones are also very effective histone deacetylase inhibitors that effectively reduce inflammatory responses. In fact, many drugs are being developed to address immune related inflammatory diseases that are HDAC inhibitors.
A safer and more rational strategy is to use a ketogenic diet, as it is one of the most effective ways to drive down your inflammation level through HDAC inhibition.
Reduced cancer risk
While all cells (including cancer cells) can use glucose for fuel, cancer cells lack the metabolic flexibility to use ketones, while regular cells thrive on these fats. Once your body enters a state of nutritional ketosis, cancer cells are more susceptible to being removed by your body through a process called autophagy. A cyclical ketogenic diet is a fundamental, essential tool that needs to be integrated in the management of nearly every cancer.
Increased muscle mass
Ketones spare branched-chain amino acids, thereby promoting muscle mass.15 However, make sure to implement cyclic ketosis. Chronic ketosis may eventually result in muscle loss as your body is impairing the mTOR pathway, which is important for anabolic growth. mTOR needs to be stimulated, just not consistently, as many people do with high protein diets.
Lowered insulin levels
Keeping your insulin level low helps prevent insulin resistance, Type 2 diabetes and related diseases. Research has demonstrated that diabetics who eat a low-carb ketogenic diet are able to significantly reduce their dependency on diabetes medication and may even reverse the condition.16
Lowering insulin resistance will also reduce your risk of Alzheimer’s. Recent research strengthens the link between insulin resistance and dementia even further, particularly among those with existing heart disease.17,18,19
Mental clarity
One of the first things people really notice once they start burning fat for fuel is that any former “brain fog” lifts, and they can suddenly think very clearly. As mentioned earlier, ketones are a preferred fuel for your brain; hence, the improved mental clarity.
Increased longevity
One of the reasons you can survive a long time without food is due to the process of ketosis, which spares protein breakdown.20 A fairly consistent effect seen in people on a ketogenic diet is that blood levels of leucine and other important structural proteins go up, allowing these proteins to perform a number of important signaling functions.
Ketones also mimic the life span extending properties of calorie restriction21 (fasting), which includes improved glucose metabolism; reduced inflammation; clearing out malfunctioning immune cells;22 reduced IGF-1, one of the factors that regulate growth pathways and growth genes and which is a major player in accelerated aging; cellular/intracellular regeneration and rejuvenation (autophagy and mitophagy).23
The Big Fat Surprise: Nina Teicholz on The Joe Rogan Experience
Cancer — Histopathologic image of colonic carcinoid.
Long-term use of the cholesterol-lowering drugs known as statins does not appear to decrease a patient’s risk of colorectal cancer, suggests a new, large case-control study from Penn Medicine researchers published this week in PLOS Medicine. The observational analysis of over 100,000 patients’ medical records suggests it is cholesterol levels that influence risk, not the much-debated statins, and that “indication bias” may explain the link between the widely-used cardiovascular drugs and risk. Such bias occurs when the indication (high cholesterol, in this case) being treated with a drug is also associated with the outcome of interest (colorectal cancer).
“There appears to be an artificially protective effect of statins,” said Ronac Mamtani, MD, MSCE, an assistant professor of Hematology/Oncology from the Perelman School of Medicine at the University of Pennsylvania and the Abramson Cancer Center, and lead author of the study. “Although the risk of colorectal cancer was lower in statin users versus non-users, when we compared those who continuedstatin therapy versus those who discontinued the therapy, such that each group shared the same indication for statin therapy, there was no difference in risk.”
Both statin use and high cholesterol have been linked to a lower colorectal cancer risk, but it has remained unclear which may be responsible for the apparent beneficial effects.
Blood cholesterol levels were inversely related to colorectal cancer risk: the higher the cholesterol level, the lower the risk for patients, regardless of statin use, the authors found. The researchers also found that an unexplained drop in cholesterol levels one year before a cancer diagnosis increased the risk of cancer in both statin users and non-users.
The findings point to a bigger role of cholesterol levels on cancer risk that could potentially serve as a blood biomarker to help diagnosis colorectal cancer earlier.
Ben Boursi, MD, a postdoctoral fellow in the Perelman School of Medicine, and Yu-Xiao Yang, MD, MSCE, an associate professor of Medicine and Epidemiology at Penn, are senior authors on the paper.
Statins are a common cholesterol-lowering treatment strategy for the management of patients at risk for coronary heart disease. Previous studies have also shown a potential reduction in cancer risk for people who take the drugs; however, they did not account for the blood cholesterol level on cancer risk, the authors said.
In the new study, the researchers compared statin use and blood cholesterol level between 22,163 patients with colorectal cancer and 86,538 patients without colorectal cancer (controls) from a database of electronic records of over 10 million patients from primary care practices in the United Kingdom.
They confirmed findings from previous studies that showed a decreased risk of colorectal cancer in statin users compared to non-users. However, they found that the difference in the risk of colorectal cancer was not significantly different between those patients who continued statin therapy and those who discontinued (OR, 0.98; 95% CI, 0.79-1.22). Furthermore, for every 1 mmol/L (~38.6 mg/dl) increase in total cholesterol level, authors observed a 10 percent decreased risk of colorectal cancer.
Additionally, they observed that decreases in total serum cholesterol (>1 mmol/L) at least a year before the cancer diagnosis were associated with 1.25-fold and 2.36-fold increased risk of colorectal cancer in users and nonusers, respectively.
“Together, these data demonstrate a complex association between statins, cholesterol, and colorectal cancer,” Mamtani said. “While unexplained decreases in blood total cholesterol should alert physicians to consider colon cancer as one potential explanation, future studies are needed to determine the utility of blood cholesterol as a marker for early detection of coloncancer.”
Nutrition professionals have an excellent track record of demonizing healthy foods.
Red meat, cheese, coconut oil… to name a few.
But the #1 worst example is their decades of propaganda against eggs, which are among thehealthiest foods on the planet.
Eggs do NOT Cause Heart Disease
Historically, eggs have been considered unhealthy because they contain cholesterol.
A large egg contains 212mg of cholesterol, which is a lot compared to most other foods.
However, it has been proven, time and time again, that eggs and dietary cholesterol do NOT adversely affect cholesterol levels in the blood.
In fact, eggs raise HDL (the good) cholesterol. They also change LDL cholesterol from small, dense LDL (which is bad) to large LDL, which is benign (1, 2, 3).
A new meta-analysis published in 2013 looked at 17 prospective studies on egg consumption and health. They discovered that eggs had no association with either heart disease or stroke in otherwise healthy people (4).
This isn’t new data. Multiple older studies have led to the same conclusion (5).
Bottom Line: Despite the fear mongering of the past few decades, eating eggs and cholesterol has no association whatsoever with heart disease.
Eggs Are Rich in Unique Antioxidants
Eggs are particularly rich in the two antioxidants Luteinand Zeaxanthine.
These antioxidants gather in the retina of the eye and protect against the eye diseases Macular Degeneration and Cataracts (6, 7, 8).
In one study, supplementing with an average of 1.3 egg yolks per day for 4.5 weeks increased blood levels of Lutein by 28-50% and Zeaxanthine by 114-142% (9).
Bottom Line: Eggs contain large amounts of the antioxidants Lutein and Zeaxanthine, which dramatically lower your risk of age-related eye disorders.
Eggs Are Among The Most Nutritious Foods on The Planet
Just think about it… one egg contains all the nutrients and building blocks required to grow an entire baby chicken.
Eggs are loaded with high-quality proteins, vitamins, minerals, good fats and various trace nutrients.
Only 77 calories, with 5 grams of fat and 6 grams of protein with all 9 essential amino acids.
Rich in iron, phosphorous, selenium and vitamins A, B12, B2 and B5 (among others).
One egg contains 113 mg of Choline – a very important nutrient for the brain, among other things. A study revealed that 90% of Americans may not get enough choline in their diet (11).
If you decide to include eggs in your diet (you should) then make sure to eat Omega-3 enriched or pastured eggs. They are much more nutritious than eggs from factory-raised chickens.
Eat the yolks, they contain pretty much all the nutrients!
Bottom Line: Eggs contain all 9 essential amino acids, are highly concentrated with vitamins and minerals and are among the best sources of choline you can get. Omega-3 enriched or pastured eggs are best.
Eggs Are Satiating and Help You Lose Weight
Eggs score high on a scale called the Satiety Index, which means that eggs are particularly capable of making you feel full and eat less overall calories (12).
Eggs only contain trace amounts of carbohydrate, which means that they will not raise blood glucose levels.
In a study of 30 overweight or obese women that ate either a bagel or eggs for breakfast, the egg group ended up eating less during lunch, the rest of the day and for the next 36 hours (13).
In another study, overweight men and women were calorie-restricted and given either a breakfast of 2 eggs (340 kcal) or an isocaloric breakfast of bagels. After 8 weeks, the egg eating group had a (14):
61% greater reduction in BMI.
65% more weight loss.
34% greater reduction in waist circumference.
16% greater reduction in body fat.
…even though both breakfasts contained the same number of calories.
Bottom Line: Eggs are a nutritious, protein rich food with a strong impact on satiety. Studies show that eating eggs for breakfast can help you lose weight.
An Egg-ceptional Superfood
If you need any more reasons to eat eggs… they are cheap, go with almost any food and taste awesome.
If there was any food I’d be willing to classify as a superfood, it would be eggs.
Eating one avocado a day as part of a heart healthy, cholesterol-lowering moderate-fat diet can help improve bad cholesterol levels in overweight and obese individuals, according to new research published in the Journal of the American Heart Association.
Researchers evaluated the effect avocados had on traditional and novel cardiovascular risk factors by replacing saturated fatty acids from an average American diet with unsaturated fatty acids from avocados.
Forty-five healthy, overweight or obese patients between the ages of 21 and 70 were put on three different cholesterol-lowering diets. Participants consumed an average American diet (consisting of 34 percent of calories from fat, 51 percent carbohydrates, and 16 percent protein) for two weeks prior to starting one of the following cholesterol lowering diets: lower fat diet without avocado, moderate-fat diet without avocado, and moderate-fat diet with one avocado per day.
The two moderate fat diets both provided 34 percent of calories as fat (17 percent of calories from monounsaturated fatty acids, whereas the lower fat diet provided 24 percent of calories as fat (11 percent from MUFAs). Each participant consumed each of the three test diet for five weeks. Participants were randomly sequenced through each of the three diets.
Researchers found:
Compared to the baseline average American diet, low-density lipoprotein (LDL) – the so called ‘bad cholesterol’ – was 13.5 mg/dL lower after consuming the moderate fat diet that included an avocado. LDL was also lower on the moderate fat diet without the avocado (8.3 mg/dL lower) and the lower fat diet (7.4 mg/dL lower), though the results were not as striking as the avocado diet.
Several additional blood measurements were also more favorable after the avocado diet versus the other two cholesterol-lowering diets as well: total cholesterol, triglycerides, small dense LDL, non-HDL cholesterol, and others.
These measurements are all considered to be cardio-metabolic risk factors in ways that are independent of the heart-healthy fatty acid effects, said Penny M. Kris-Etherton, Ph.D., R.D., senior study author and chair of the American Heart Association’s Nutrition Committee and Distinguished Professor of Nutrition at Pennsylvania State University in University Park, Pennsylvania.
“This was a controlled feeding study, but that is not the real-world – so it is a proof-of-concept investigation. We need to focus on getting people to eat a heart-healthy diet that includes avocados and other nutrient-rich food sources of better fats,” Kris-Etherton said.
“In the United States avocados are not a mainstream food yet, and they can be expensive, especially at certain times of the year. Also, most people do not really know how to incorporate them in their diet except for making guacamole. But guacamole is typically eaten with corn chips, which are high in calories and sodium. Avocados, however, can also beeaten with salads, vegetables, sandwiches, lean protein foods (like chicken or fish) or even whole.”
For the study researchers used Hass avocados, the ones with bumpy green skin. In addition to MUFAs, avocados also provided other bioactive components that could have contributed to the findings such as fiber, phytosterols, and other compounds.
According to researchers, many heart-healthy diets recommend replacing saturated fatty acids with MUFAs orpolyunsaturated fatty acids to reduce the risk of heart disease. This is because saturated fats can increase bad cholesterol levels and raise the risk of cardiovascular disease.
The Mediterranean diet, includes fruits, vegetables, whole grains, fatty fish, and foods rich in monounsaturated fatty acids—like extra-virgin olive oil and nuts. Like avocados, some research indicates that these not only contain better fats but also certain micronutrients and bioactive components that may play an important role in reducing risk of heart disease.
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