High Cholesterol

    Researchedby:
    Mike Murray

    Fact-checked

    by:

    Nick Milazzo, James Gaylor
    Last Updated: October 13, 2024

    High amounts of low-density lipoproteins cause fatty plaques to build up in the arteries, which restricts blood flow and can cause health problems like a heart attack. Lifestyle factors (e.g., poor diet, smoking) and genetics play a huge role in blood cholesterol levels.

    High Cholesterol falls under the Cardiovascular Health category.

    87 references on this page
    88,240 participants in 165 trials and 31 meta-analyses

    What is high cholesterol?

    Cholesterol is a waxy, fat-like substance present in all cells and in the blood. Cholesterol is carried through the blood on lipoproteins (e.g., low-density lipoprotein (LDL), high-density lipoprotein (HDL). High amounts of LDL particles cause plaque (i.e., fatty deposits) to build up in the arteries.[1] Plaque hardens and narrows arteries, which restricts blood flow to areas of the body like the heart or brain and can cause a heart attack or stroke.

    What are the main signs and symptoms of high cholesterol?

    There are usually no signs or symptoms of high cholesterol. People with severely elevated LDL levels due to a genetic disorder may present with fatty skin deposits called xanthomas over parts of the hands, elbows, knees, ankles, or around the cornea of the eye.

    How is high cholesterol diagnosed?

    High cholesterol is diagnosed using a blood test. Generally, LDL isn’t measured directly, but is instead estimated using LDL-cholesterol (LDL-C), which is a measure of the total amount of cholesterol contained within LDL particles and is highly correlated with LDL particle number.[1] Blood samples can be collected in a fasted or nonfasted state.[2] For people at low cardiovascular risk, an LDL-C goal of <116 mg/dL is recommended.[3]

    What are some of the main medical treatments for high cholesterol?

    Pharmacotherapy typically begins with a statin prescribed up to the highest tolerated dose to reach the LDL-C goal set for the individual.[2] If the LDL-C goal is not achieved with the maximum tolerated dose of a statin, combination therapy with ezetimibe is recommended.[2] If the LDL-C goal is still not met, the addition of a PCSK9 inhibitor is recommended.[2]

    Have any supplements been studied for high cholesterol?

    The supplement with the largest effect on LDL-C is red yeast rice, which is an inhibitor of endogenous cholesterol synthesis and works via the same mechanism of action as statins.[4] Other supplements that can improve LDL-C are garlic,[5] plant sterols and stanols,[6] and beta-glucan (a soluble fiber primarily found in oats and barley).[7]

    How could diet affect high cholesterol?

    Diet directly influences blood cholesterol levels. trans fats and saturated fats have the greatest effect on LDL-C, so replacing foods rich in these nutrients with foods rich in polyunsaturated or monounsaturated fat, and to a lesser extent whole-grain carbohydrates (especially ones rich in soluble fiber), reduces LDL-C.[2]

    Plant-based dietary patterns, including the Mediterranean diet, Portfolio diet, and Dietary Approaches to Stop Hypertension (DASH) diet, can reliably improve LDL-C.[8]

    Does the DASH diet do anything else besides lower blood pressure?

    What exactly should I eat to adhere to the DASH diet?

    What other foods are known to impact cholesterol levels and heart health?

    Are fully hydrogenated oils a health concern?

    Is saturated fat bad for your health?

    Will eating eggs increase my cholesterol?

    Are there any other treatments for high cholesterol?

    Because excess body weight and abdominal fat contribute to high cholesterol, 150–300 minutes of moderate-intensity physical activity plus ≥ 2 resistance exercise sessions per week are recommended to support weight loss (5–10% of initial body weight), and more importantly, the maintenance of a healthy body weight.[2] Other lifestyle modifications include limiting alcohol consumption (≤ 10 grams of pure alcohol per day) and quitting smoking.[2]

    What causes high cholesterol?

    High cholesterol is often caused by lifestyle habits, such as an unhealthy dietary pattern. However, genetics also strongly influence cholesterol levels. In people with familial hypercholesterolemia (FH), for example, there is typically a defect in the LDL receptor, which reduces the rate of LDL removal from the blood.[9] FH is treated with pharmacotherapy, as lifestyle modifications alone are insufficient to achieve a healthy LDL-C level.

    Examine Database: High Cholesterol

    Fish Oil
    Garlic
    Curcumin
    Policosanol
    L-Carnitine
    Chromium
    Conjugated Linoleic Acid
    Ketogenic Diet
    Psyllium
    Saffron
    Spirulina
    Vegan Diet
    Vitamin C
    Flaxseed
    Hesperidin
    Red Clover Extract
    Artichoke Extract
    Chlorella
    Lactobacillus Reuteri
    Roselle
    Apple Cider Vinegar
    Berberine
    Coenzyme Q10
    Dietary Approaches to Stop Hypertension (DASH) Diet
    Dill
    Ginger
    Guggul
    Kefir
    Mediterranean Diet
    Microlactin
    Pomegranate seed oil
    Pyruvate
    Resveratrol
    Sauna
    Soy Protein
    Tetradecyl Thioacetic Acid
    Whey Protein
    Yerba Mate
    Ashwagandha
    Astaxanthin
    Beta-glucans
    Betaine
    Bitter Cucumber
    Black Chokeberry
    Black Cohosh
    Black seed
    Blueberry
    Casein
    Coffee
    Colostrum
    Creatine
    Docosahexaenoic Acid
    Ecklonia Cava
    Eicosapentaenoic Acid
    Ephedrine
    Gamma Oryzanol
    Grape Juice
    Gymnema Sylvestre
    Hemp Protein
    Inositol
    Krill Oil
    Melatonin
    Milk Protein
    Nattokinase
    Niacin (Vitamin B3)
    Olive Leaf Extract
    Perilla
    Pterostilbene
    Pueraria Mirifica
    Quercetin
    Reishi
    Rose Hip
    Safflower Oil
    Soy Lecithin
    Taurine
    Theaflavins
    Vitamin D
    Vitamin E

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    Frequently asked questions

    What is high cholesterol?

    Cholesterol is a waxy, fat-like substance present in all cells and in the blood. Cholesterol is carried through the blood on lipoproteins (e.g., low-density lipoprotein (LDL), high-density lipoprotein (HDL). High amounts of LDL particles cause plaque (i.e., fatty deposits) to build up in the arteries.[1] Plaque hardens and narrows arteries, which restricts blood flow to areas of the body like the heart or brain and can cause a heart attack or stroke.

    What are the main signs and symptoms of high cholesterol?

    There are usually no signs or symptoms of high cholesterol. People with severely elevated LDL levels due to a genetic disorder may present with fatty skin deposits called xanthomas over parts of the hands, elbows, knees, ankles, or around the cornea of the eye.

    How is high cholesterol diagnosed?

    High cholesterol is diagnosed using a blood test. Generally, LDL isn’t measured directly, but is instead estimated using LDL-cholesterol (LDL-C), which is a measure of the total amount of cholesterol contained within LDL particles and is highly correlated with LDL particle number.[1] Blood samples can be collected in a fasted or nonfasted state.[2] For people at low cardiovascular risk, an LDL-C goal of <116 mg/dL is recommended.[3]

    What are some of the main medical treatments for high cholesterol?

    Pharmacotherapy typically begins with a statin prescribed up to the highest tolerated dose to reach the LDL-C goal set for the individual.[2] If the LDL-C goal is not achieved with the maximum tolerated dose of a statin, combination therapy with ezetimibe is recommended.[2] If the LDL-C goal is still not met, the addition of a PCSK9 inhibitor is recommended.[2]

    Have any supplements been studied for high cholesterol?

    The supplement with the largest effect on LDL-C is red yeast rice, which is an inhibitor of endogenous cholesterol synthesis and works via the same mechanism of action as statins.[4] Other supplements that can improve LDL-C are garlic,[5] plant sterols and stanols,[6] and beta-glucan (a soluble fiber primarily found in oats and barley).[7]

    How could diet affect high cholesterol?

    Diet directly influences blood cholesterol levels. trans fats and saturated fats have the greatest effect on LDL-C, so replacing foods rich in these nutrients with foods rich in polyunsaturated or monounsaturated fat, and to a lesser extent whole-grain carbohydrates (especially ones rich in soluble fiber), reduces LDL-C.[2]

    Plant-based dietary patterns, including the Mediterranean diet, Portfolio diet, and Dietary Approaches to Stop Hypertension (DASH) diet, can reliably improve LDL-C.[8]

    Does the DASH diet do anything else besides lower blood pressure?

    The DASH diet was actually ranked as U.S News’ Best Overall Diet (tied with the Mediterranean Diet). It is not only good for lowering blood pressure, but has also been shown to lower LDL-C.[10] It is also a good choice for weight loss[11] and may also reduce the risk of colorectal cancer.[12]

    What exactly should I eat to adhere to the DASH diet?

    According to the National Heart, Lung, and Blood Institute, the DASH diet recommends eating vegetables, fruits, and whole grains, including fat-free or low-fat dairy products, fish, poultry, beans, nuts, and vegetable oils; limiting foods that are high in saturated fat (e.g., fatty meats, full-fat dairy products, and tropical oils like coconut, palm kernel and palm oils); and limiting sweets and sugar-sweetened beverages. A 2,000 kcal daily diet would include 6-8 servings of grains, 6 or less servings of meat, poultry or fish, 4-5 servings of vegetables, 4-5 servings of fruit, 2-3 servings of low fat or fat-free dairy products, 2-3 servings of fats and oils, and either 2,300 milligrams of sodium or 1,500 milligrams of sodium, which is roughly half[13] of what the typical American consumes. In addition, the diet would include 4-5 weekly servings of nuts, beans, seeds, or peas and 5 or less servings of sweets.

    What other foods are known to impact cholesterol levels and heart health?

    Other foods that are usually high in saturated fat include red meat, processed meat, pastries, fried snacks, cakes, and full fat dairy products like cream and cheese. There is some research that suggests that the type of saturated fat found in dairy (odd-chain fatty acids[14] and a trans fat called CLA) may have a protective effect on CVD risk.[15] Other properties of full-fat dairy may also have an effect. For example, butter, which contains a low level of intact milk fat globule membranes (MFGM),[16] is seen to increase LDL-C to a higher degree than cream, which contains more MFGM. But stronger evidence is needed before full-fat dairy can be recommended as a heart-healthy food.

    There is also good evidence that a high intake of fruit and vegetables[17] and including plenty of fiber[18] in the diet (which can be found in fruits, vegetables, legumes, and whole grains), reduces CVD risk. Similarly, consuming oily fish has been shown to increase HDL-cholesterol and reduce triglyceride levels.[19] However, in a similar way that olive oil is seen to be more beneficial than MUFA on its own, omega-3 supplements are not observed to have the same protective effect on CVD risk,[20] compared to consuming fish.[21]

    Are fully hydrogenated oils a health concern?

    Fully hydrogenated oils come with similar health concerns as saturated fat, because full hydrogenation of the oil eliminates the trans- double-bonds and creates what is essentially a saturated fatty acid. Although the debate concerning the health effects of saturated fatty acids is ongoing, it is notable that the most common fatty acid produced through full hydrogenation is stearic acid, which has a neutral effect on blood lipids.[22]

    Is saturated fat bad for your health?
    Quick answer:

    Compared to carbs and unsaturated fat, saturated fat has been linked to an increase in some risk factors for heart disease. However, by focusing on a nutrient in isolation, we risk missing the bigger picture: what matters most is your overall diet and lifestyle.

    The fat you eat (and the fat you store in your body) is made up of different types of fatty acids, each with a long chain of carbon atoms bonded together. Saturated fatty acids (SFAs) have no double bonds, whereas monounsaturated fatty acids (MUFAs) have one and polyunsaturated fatty acids (PUFAs) have two or more. The “kinks” those bonds form in fatty acid chains prevent the fatty acids from packing close together, which is why unsaturated fats are liquid at room temperature, whereas saturated fats usually aren’t (they’re packed solid).

    image

    Saturated fats are fatty acids with no double bonds, which is why they are usually solid at room temperature.

    However, classifying fatty acids by degree of saturation does not predict how they are handled by the body.[23] Based on the length of its tail (the number of carbons in its chain), a saturated fat belongs to one of four main subcategories, each with its own biological effects.

    image

    Even within each subcategory, the various fatty acids have different health effects.

    For example, although palmitic acid and stearic acid are both long-chain saturated fats, the former causes a greater increase in blood cholesterol levels.[24] Similarly, although caprylic acid and capric acid are both medium-chain saturated fats, the former results in a larger blood ketone response.[25]

    Those variations greatly limit our ability to discuss saturated fat in general. Just as it would be inappropriate to generalize the effects of poisonous mushrooms to all mushrooms, it is inappropriate to generalize the effects of one kind of saturated fat to all kinds of saturated fat.

    Saturated fats differ by their length (as indicated by the number of carbons in the fatty acid chain) and can each have unique biological effects.

    Medium-chain triglycerides, aka MCTs

    Medium-chain triglycerides (MCTs) are saturated fats containing 6–10 carbons. Long-chain triglycerides (LCTs) are saturated fats containing 12–18 carbons.

    The ketogenic nature of MCTs has led to a growing interest in their use as a food supplement. Traditionally, they’ve served to mimic a ketogenic diet (a very restrictive, very-low-carbohydrate diet) in children with epilepsy.[26] Today, MCTs are also advertised as helping with fat loss, exercise performance, and brain health, though the evidence is limited.

    The richest natural source of MCTs, coconut oil, is ≈14% MCTs by weight,[27] so you’d need to eat 100 grams of fat (900 kcal) from coconut oil to consume 14 grams (1 tablespoon) of MCTs. For that reason, people interested in MCTs usually turn to concentrated MCT oils.

    Medium-chain triglycerides (MCTs) and long-chain triglycerides (LCTs) are two groups of saturated fats. Your body metabolizes MCTs and LCTs very differently. Unlike LCTs, MCTs are not easily obtained in large quantities from whole foods (the best source is coconut oil, but you would need to eat 7 tablespoons to obtain 1 tablespoonful of MCTs), so they won’t be considered throughout this article.

    Why do people think saturated fat is so unhealthy?

    A quick history lesson on why people think saturated fat is unhealthy.

    Since the 1950s, many studies have linked the consumption of saturated fat with increases in blood cholesterol levels.[28] Those studies, combined with observational research on the association between diet and heart disease,[29] led Dr. Ancel Keys to propose the diet-heart hypothesis, which suggests that saturated fat raises blood cholesterol levels and thus increases the risk of heart disease.[30][31]

    image

    Despite some researchers arguing that there were significant flaws in the data Keys used to support his claims,[32] the diet-heart hypothesis persisted and resulted in the belief that a heart-healthy diet should limit saturated fat. Within the academic and medical communities, this conclusion was widely accepted as fact, and it influences official dietary guidelines even today.

    Research conducted throughout the later half of the 1900s led Dr. Ancel Keys to propose the diet-heart hypothesis, which posits that dietary saturated fat raises blood cholesterol levels and thus increases the risk of heart disease.

    Saturated fat and your heart

    Since the diet-heart hypothesis led to official recommendations against saturated-fat intake, it makes sense to address heart disease first.

    How does arterial plaque form?

    Our arteries are lined with a layer of cells called the endothelium, which functions as a selectively permeable barrier between our blood and the rest of our body. This is akin to our intestinal tract, which allows for the absorption of some nutrients but not others. In our blood, one of the “nutrients” that penetrates the endothelium is low-density lipoprotein (LDL), whose primary job is to transport cholesterol throughout the body.

    The key event for the formation of plaques in arteries is the retention of LDL particles in the space beneath the endothelium (called the intima).[33] Once there, LDL is more susceptible to becoming oxidized, which signals the immune system to attack because oxidized LDL is seen as harmful to the body. This inflammatory response involves certain white blood cells called macrophages that literally “eat” the oxidized LDL particles. The LDL-engulfing process turns macrophages into foam cells, which can’t function properly and accumulate into the fatty build-up we call plaque.

    image

    As you can see, several events need to occur for heart disease to develop. This helps explain why heart disease has numerous environmental and genetic risk factors such as diabetes, obesity, smoking, lack of exercise, and infection.[34]

    Any process that affects LDL retention and oxidation or inflammation is going to influence plaque formation and the risk of suffering from heart disease. Therefore, it makes sense to look at how saturated fat affects each of these processes.

    Heart disease is most commonly the result of atherosclerosis (the buildup of plaque in arteries). Atherosclerosis happens when LDL particles penetrate arterial walls, become oxidized, and are attacked by white blood cells.

    Effects of saturated fat on blood lipids

    Saturated fat’s effects on blood lipids were thoroughly investigated in a systematic review and meta-analysis published by the World Health Organization (WHO) in 2016.[35] This meta-analysis included 84 randomized controlled trials (RCTs) involving a total of 2,353 healthy adults; it evaluated the effects of replacing 1% of caloric intake from carbohydrates or unsaturated fats with 1% of caloric intake from saturated fat.

    To be included in the analysis, all studies were required to meet stringent criteria, so as to best isolate the effects of dietary substitution. For example, all food was provided to the participants, calories and protein were matched between diets, and all interventions lasted at least two weeks. The results are summarized in the table below.

    image

    Eating saturated fat instead of unsaturated fat or carbohydrates consistently increased lipid and lipoprotein concentrations in the blood. The one exception was a reduction in triglycerides when saturated fat was consumed instead of carbohydrates. Importantly, these effects were found to be consistent between sexes and across a wide range of baseline blood-lipid values and saturated-fat intakes (1.6–24.4% of calories). They were also consistent between studies, whatever the year of publication.

    An important limitation of this meta-analysis is that it could not differentiate between the various food sources of the nutrients, which is an important consideration we shall discuss later. Moreover, studies investigating hydrogenated oils, fish oils, and medium-chain triglycerides were excluded.

    Saturated fat increases lipid and lipoprotein concentrations in the blood when compared to carbohydrates, monounsaturated fat, and polyunsaturated fat.

    LDL and HDL

    Compared to carbohydrates and unsaturated fats, saturated fat raises the levels of lipoproteins and most blood lipids. These changes have well-researched implications for the risk of developing heart disease.

    The greater the number of LDL particles in the blood (LDL-P), the more likely some will pass into artery walls, become oxidized, and kickstart plaque formation.[33] Therefore, to predict heart disease, LDL-P matters more than LDL-C,[36][37] which is simply a measure of the amount of cholesterol being carried by LDL particles.

    If two people have the same LDL-C but one has cholesterol-rich LDL (large, “fluffy” particles) and the other cholesterol-poor LDL (smaller, denser particles), the second will have a greater LDL-P (more LDL particles total) and be at greater risk of heart disease.

    The WHO meta-analysis didn’t cover LDL-P.[35] However, it did report the levels of apolipoprotein B (apoB), the protein component of LDL. Since each LDL particle has one molecule of apoB, apoB concentrations provide a good estimate of LDL-P concentrations and are a strong predictor of heart disease risk.[38][39]

    To predict heart disease, LDL-P (the number of LDL particles) matters more than LDL-C (the amount of cholesterol those particles carry). There is one molecule of apolipoprotein B (apoB) in each LDL particle, so apoB is a good estimate of LDL-P. Consuming saturated fat (instead of unsaturated fat) increases apoB concentrations — and therefore your heart-disease risk.

    High-density lipoprotein (HDL) removes cholesterol from arteries and plaques, protects the endothelium from damage, and inhibits LDL oxidation.[40]

    HDL basically does the opposite of LDL. While calling HDL-C “good cholesterol” and LDL-C “bad cholesterol” is simplistic, studies do show that a higher ratio of LDL-C to HDL-C (and of total cholesterol to HDL-C) leads to a higher risk of heart disease. Those ratios matter more than your absolute numbers for LDL-C, HDL-C, and even total cholesterol.[41]

    The WHO meta-analysis reported that eating more saturated fat increased HDL-C, but the increase was one-tenth that of LDL-C. Therefore, the ratio of LDL-C to HDL-C (and of total cholesterol to HDL-C) increased,[35] and with it the risk of heart disease.

    A similar pattern was seen with apoA1, the major protein component of HDL particles, akin to apoB for LDL particles. Although replacing unsaturated fat by saturated fat led to increases in apoA1, the increase was only 30–60% that in apoB.[35] The ratio of apoB to apoA1 is considered a better predictor of heart-disease risk than other blood lipid biomarkers and their ratios.[42][43] If apoB increases more than apoA1, then the apoB-to-apoA1 ratio increases, and with it the risk of heart disease.

    The HDL-C and apoA1 numbers reflect the amount of HDL in the blood. HDL has cardioprotective effects, but while eating saturated fat (instead of unsaturated fat) increases both HDL-C and apoA1, it increases LDL-C and apoB even more.

    Finally, the triglyceride to HDL-C ratio represents a strong, independent predictor of heart disease when LDL-C levels are below 160 mg/dL,[44] and has similar predictive ability as LDL-C for determining the extent of atherosclerosis in at-risk patients.[45] Having a triglyceride-to-HDL-C ratio above 3.8 is associated with having more small, dense LDL particles, which are especially susceptible to oxidation.[46]

    The WHO meta-analysis reported that eating more polyunsaturated fat reduced the ratio, whereas eating more carbohydrates increased it, when saturated-fat intake was reduced.[35] However, the changes were very small and not of clinical significance. A 10% reduction in calories from saturated fat would increase the triglyceride-to-HDL-C ratio by a mere 0.16 if more carbohydrates were eaten, and decrease it by only 0.04 if more polyunsaturated fat were eaten.

    The triglyceride-to-HDL-C ratio correlates with the number of small, dense LDL particles and represents a strong risk factor for heart disease. However, changes in saturated-fat intake have little effect on this ratio.

    Effects of saturated fat on inflammation

    Plaque development requires that the immune system attack oxidized LDL particles within the arteries. Therefore, reducing systemic inflammation could help fight atherosclerosis, and in this manner decrease the risk of heart disease.[47][48]

    Saturated fat may worsen systemic inflammation by increasing the absorption of lipopolysaccharides (LPS),[49] which are bacterial endotoxins that strongly stimulate our immune system.[50][51] Even very small serum concentrations of LPS, on a picogram scale, have the potential to elicit in humans an inflammatory response with a clear dose-response relationship.[52]

    However, a systematic review found no consistent associations between consumption of saturated fat and a variety of inflammatory biomarkers, including cytokines, adipokines, acute-phase reactants, and cell adhesion molecules.[53] Clearly, the role of saturated fat on inflammation is not straightforward.

    Still, one RCT reported that, compared to a diet high in SFAs, a diet high in MUFAs decreased LDL oxidation, a diet high in omega-6 (n-6) PUFAs increased it, and a diet high in omega-3 (n-3) PUFAs did not affect it.[54] The study authors attributed those differences to the fatty-acid composition of the LDL particles (i.e., to whether they contained mostly SFAs, MUFAs, or either kind of PUFAs).

    Saturated fat may raise endotoxin levels to a greater extent than unsaturated fat, but it does not appear to affect systemic inflammation. Omega-6 polyunsaturated fat appears to increase LDL oxidation more than saturated fat (which is bad), whereas monounsaturated fat significantly reduces it (which is good).

    Effects of saturated fat on heart disease

    Up to this point, we have reviewed the effects of saturated fat on heart-disease risk factors rather than on heart disease itself.

    The step between the two should be a small one, but that’s where things turn weird: despite a logical theoretical framework connecting diets high in saturated fat to atherosclerosis, meta-analyses of observational studies haven't reported consistently strong associations between saturated fat intake and risk of coronary heart disease, stroke, or cardiovascular disease in general.[55][56]

    Even long-term RTCs that assessed hard endpoints of heart disease (such as suffering a heart attack, or dying from one) reported inconsistent links with saturated-fat intake. For instance, one meta-analysis reported that every 5% reduction in calories from SFAs (replaced by PUFAs) reduced the risk of heart disease by ≈10%,[57] but another reported that replacing SFAs by PUFAs was protective only when the PUFAs included both n-3 and n-6 fatty acids — replacing SFAs by only n-6 PUFAs tended to increase the risk of heart disease.[58]

    One reason for the discrepancies is the failure of many studies to isolate the effects of altering saturated-fat intake. For example, some studies gave dietary advice to only one of the intervention groups — advice such as eating more plant-based foods; eating more n-3 PUFAs from fish and seafood; eating less sugar; and eating less trans-fat from margarines, shortenings, and partially hydrogenated oils.[59] When looking only at trials that minimized confounding factors, we see that replacing SFAs with primarily n-6 PUFAs has no effect on the risk of developing heart disease or dying from it.[59]

    Neither observational studies nor RCTs support the notion that eating a diet high in saturated fat strongly increases the risk of developing heart disease or dying from it.

    Understanding the difference between heart-disease risk factors and actual rates of heart disease

    So, what gives? We have evidence that eating more saturated fat (instead of unsaturated fat) increases known risk factors for heart disease, such as blood lipids, but studies looking at the big picture do not find a link between saturated fat and heart disease. How can this be?

    The simple answer is that fat intake is but a single piece of the heart-disease puzzle. Eating more saturated fat may increase your risk of developing heart disease, but that doesn’t mean you will develop heart disease. Conversely, banning all saturated fat from your diet does not make your heart attack proof.

    In other words, rather than singling out any food or nutrient, we need to consider a person’s overall diet and lifestyle.

    Let us use dairy as an example.

    Dairy fat is ≈70% saturated fat,[60] making it a prime target for nutritional interventions. However, results from observational and experimental studies on the effects of dairy products on blood lipid levels are not conclusive,[61][62] and can even appear contradictory. For instance, there is RCT evidence that diets high in saturated fat from butter increase LDL-C, but that diets equally high in saturated fat from cheese might not.[61] Different dairy products, such as butter and cheese, have different food matrices (structures in which the food compounds are arranged), and thus different metabolic effects.[16]

    Similarly, one meta-analysis reported a lack of significant associations between heart disease mortality and high intakes of meat or dairy products (including milk and cheese). [63] However, high intakes of processed meat did increase the risk of heart disease. It is well established that processed meats contain several carcinogenic compounds, which can influence heart disease risk.[64]

    Whether saturated fat is good or bad for your heart may depend on what it is replacing — or being replaced by — in your diet. For example, replacing saturated fat by carbohydrates from whole grains is associated with a reduced risk of heart disease, whereas replacing saturated fat by carbohydrates from refined grains fails to confer the same benefit.[65] Similarly, replacing SFAs by plant-based MUFAs is associated with a reduced risk of heart disease, whereas replacing SFAs by animal-based MUFAs is not.[66]

    If you care about your heart, you can’t just focus on saturated fat — or on any other nutrient. You need to look at the foods that provide it, and beyond that, at your overall diet and lifestyle. Doing otherwise means missing the forest for the trees.

    Saturated fat and your brain

    Studies in animal models and test tubes generally support the position that, compared to diets high in MUFAs or n-3 PUFAs, diets high in SFAs (and, to a lesser extent, diets high in n-6 PUFAs) have detrimental effects on brain development and cognitive function.[67][68] However, whether results in animals can be applied to humans is questionable.

    Unfortunately, human studies are scarce. One study reported that eating a diet high in SFAs (from palm oil) increased self-reported anger (4.7 vs. 2.2 out of 5 points) and overall mood disturbances (13 vs. 7 out of 20 points) compared to eating a diet high in MUFAs (from hazelnut oil).[69] Other studies have reported that eating SFAs alters brain activation during cognitive tests and at rest, although the implications of these findings are not known.[70][71]

    Studies in animals suggest that diets high in saturated fat may impair cognitive function and brain development. However, studies in humans are few and inconclusive.

    Saturated fat and your weight

    Appetite

    Weight gain or loss depends greatly on caloric intake. According to a review of 24 studies, different types of fat affect subjective appetite similarly, at least in the short-term (e.g., single-meal assessments), in spite of satiety hormones being affected more by saturated than unsaturated fat.[72] However, differences in study protocols and participants make it difficult to draw overarching conclusions.

    The effects of fat type on appetite regulation are not clear, but compared to monounsaturated and polyunsaturated fats, saturated fat appears to be either equally filling or slightly less filling.

    Thermogenesis

    Compared to meals high in unsaturated fat, meals high in saturated fat tend to result in lower levels of post-meal energy expenditure and fatty-acid oxidation.[73] Studies using isotope tracers indicate that the body would rather use unsaturated than saturated fats as an energy source.[74][75] However, long-term studies are inconsistent.[73]

    Compared to unsaturated fat, saturated fat reduces energy expenditure and fat oxidation, but the long-term implications are not clear.

    Activity

    Eating more monounsaturated fat in place of saturated fat appears to spontaneously increase physical activity levels.[69]

    Compared to unsaturated fat, saturated fat might reduce energy expenditure via reductions in physical activity.

    Saturated fat and your hormones

    Testosterone

    Several RCTs have been conducted to evaluate the effects of dietary fat (amount and type) on men’s testosterone levels. To best understand these studies, we must first briefly discuss what they measured.

    • Tightly bound testosterone. About two-thirds of the testosterone in your blood is bound to sex-hormone-binding globulin (SHBG). Your body can’t use it.
    • Loosely bound testosterone. About a third of the testosterone in your blood is bound to albumin. Your body can use it, with some effort.
    • Free testosterone. A small percentage of the testosterone in your blood (1–4%, as a rule) just floats around freely. Your body can readily use it.

    Together, your loosely bound testosterone and your free testosterone compose your bioavailable testosterone, which has a greater impact on your health than your total testosterone.

    Two studies with large sample sizes, controlled diets, and direct measurement of free testosterone reported that, compared to high-fat diets (33–40% of calories), low-fat diets (14–19% of calories) reduced total testosterone levels in healthy men, but did not alter levels of free or bioavailable testosterone.[76][77] Two other studies with smaller sample sizes, less accurate measurement methods, and less dietary control reported reductions in both total and free testosterone levels.[78][79]

    Compared to diets high in fat (30–40% of calories), diets low in fat (14–19% of calories) appear to reduce total testosterone levels, but not necessarily free testosterone levels. In all cases, the reductions are fairly small and not clinically significant.

    The big picture

    Compared to monounsaturated fat (MUFAs) and omega-6 polyunsaturated fat (n-6 PUFAs), saturated fat (SFAs) does increase several risk factors for heart disease. However, compared to n-6 PUFAs only, SFAs also reduce some risk factors. In other words, eating more MUFAs appears to have the most favorable effect on risk factors for heart disease overall, whereas SFAs and n-6 PUFAs are on relatively equal footing.

    There is some evidence that, compared to monounsaturated fat, saturated fat might have a negative effect on cognition, appetite, and energy expenditure; but further research is required.

    A diet low in fat (14–19% of calories) might reduce total testosterone levels by 10–15% in otherwise healthy men. Total testosterone remains within normal range, however, and the biologically active free testosterone appears unaffected. Clinical significance is not known.

    Will eating eggs increase my cholesterol?
    Quick answer:

    Eggs increasing cholesterol depends on your genetics. They don't seem to increase the risk of heart disease unless you have a poor diet.

    Historically, nutrition guidelines for reducing the risk of cardiovascular disease (CVD) have included recommendations to limit dietary cholesterol. However, the 2015–2020 Dietary Guidelines for Americans did not issue explicit guidance for dietary cholesterol intake due to inconsistencies in the evidence base. Does this mean eggs can be on the breakfast menu every day without raising CVD risk?

    Eggs are a relatively inexpensive and nutrient-dense food. They are a high-quality source of protein and rich in choline, vitamin B2, and the carotenoids lutein and zeaxanthin.[80] They also contain a notable amount of cholesterol: about 186 mg per large egg.

    Evidence from randomized controlled trials (RCTs) demonstrates that foods high in cholesterol increase low-density lipoprotein cholesterol (LDL-C),[81] which increases the risk of CVD.[1] More specifically, it’s reported that the consumption of more than 1 egg per day increases LDL-C by about 7.7 mg/dL (0.2 mmol/L), with similar effects in healthy people and people with dyslipidemia.[82]

    Nonetheless, studies report the average response and the individual response to dietary cholesterol is highly variable. It appears that the majority of people are able to roughly maintain LDL-C in response to an increase in dietary cholesterol intake.[83][84][85] This lack of response is due to a combination of suppression in endogenous cholesterol synthesis, a reduction in dietary cholesterol absorption, and an increase in biliary excretion of cholesterol.[86]

    On the other hand, there is a notable subset of individuals who, partly due to genetic differences, lack these feedback control mechanisms and experience a significant increase in LDL-C in response to increases in dietary cholesterol intake (i.e., hyper-responders).[87] In this population, it may be particularly worthwhile to limit egg consumption to prevent LDL-C from rising to an unhealthy level.

    For many people, moderate egg consumption is permissible and possibly even beneficial as part of an otherwise healthy diet. However, hyper-responders and people with high cholesterol or dyslipidemia may benefit from limiting their egg consumption or removing eggs from the diet altogether, as this can lead to a clinically meaningful decrease in LDL-C.[2]

    Are there any other treatments for high cholesterol?

    Because excess body weight and abdominal fat contribute to high cholesterol, 150–300 minutes of moderate-intensity physical activity plus ≥ 2 resistance exercise sessions per week are recommended to support weight loss (5–10% of initial body weight), and more importantly, the maintenance of a healthy body weight.[2] Other lifestyle modifications include limiting alcohol consumption (≤ 10 grams of pure alcohol per day) and quitting smoking.[2]

    What causes high cholesterol?

    High cholesterol is often caused by lifestyle habits, such as an unhealthy dietary pattern. However, genetics also strongly influence cholesterol levels. In people with familial hypercholesterolemia (FH), for example, there is typically a defect in the LDL receptor, which reduces the rate of LDL removal from the blood.[9] FH is treated with pharmacotherapy, as lifestyle modifications alone are insufficient to achieve a healthy LDL-C level.

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    96. Blood glucose - Andersson U, Berger K, Högberg A, Landin-Olsson M, Holm CEffects of rose hip intake on risk markers of type 2 diabetes and cardiovascular disease: a randomized, double-blind, cross-over investigation in obese personsEur J Clin Nutr.(2012 May)
    97. Blood glucose - Maeba R, Hara H, Ishikawa H, Hayashi S, Yoshimura N, Kusano J, Takeoka Y, Yasuda D, Okazaki T, Kinoshita M, Teramoto TMyo-inositol treatment increases serum plasmalogens and decreases small dense LDL, particularly in hyperlipidemic subjects with metabolic syndromeJ Nutr Sci Vitaminol (Tokyo).(2008 Jun)
    98. Blood glucose - Englisch W, Beckers C, Unkauf M, Ruepp M, Zinserling VEfficacy of Artichoke dry extract in patients with hyperlipoproteinemiaArzneimittelforschung.(2000 Mar)
    99. High-density lipoprotein (HDL) - Bundy R, Walker AF, Middleton RW, Wallis C, Simpson HCArtichoke leaf extract (Cynara scolymus) reduces plasma cholesterol in otherwise healthy hypercholesterolemic adults: a randomized, double blind placebo controlled trialPhytomedicine.(2008 Sep)
    100. Total cholesterol - Lupattelli G, Marchesi S, Lombardini R, Roscini AR, Trinca F, Gemelli F, Vaudo G, Mannarino EArtichoke juice improves endothelial function in hyperlipemiaLife Sci.(2004 Dec 31)
    101. Blood glucose - Castilla P, Echarri R, Dávalos A, Cerrato F, Ortega H, Teruel JL, Lucas MF, Gómez-Coronado D, Ortuño J, Lasunción MAConcentrated red grape juice exerts antioxidant, hypolipidemic, and antiinflammatory effects in both hemodialysis patients and healthy subjectsAm J Clin Nutr.(2006 Jul)
    102. Blood glucose - Kuriyan R, Kumar DR, R R, Kurpad AVAn evaluation of the hypolipidemic effect of an extract of Hibiscus Sabdariffa leaves in hyperlipidemic Indians: a double blind, placebo controlled trialBMC Complement Altern Med.(2010 Jun 17)
    103. Apolipoprotein A - Mozaffari-Khosravi H, Jalali-Khanabadi BA, Afkhami-Ardekani M, Fatehi FEffects of sour tea (Hibiscus sabdariffa) on lipid profile and lipoproteins in patients with type II diabetesJ Altern Complement Med.(2009 Aug)
    104. Weight - Hernández-Pérez F, Herrera-Arellano ATherapeutic use Hibiscus sabadariffa extract in the treatment of hypercholesterolemia. A randomized clinical trialRev Med Inst Mex Seguro Soc.(2011 Sep-Oct)
    105. Blood glucose - Kastorini, C.M., et al.The effect of Mediterranean diet on metabolic syndrome and its components: a meta-analysis of 50 studies and 534,906 individualsJ Am Coll Cardiol.(2011-03-15)
    106. Endothelial Function - Shannon OM, Mendes I, Köchl C, Mazidi M, Ashor AW, Rubele S, Minihane AM, Mathers JC, Siervo MMediterranean Diet Increases Endothelial Function in Adults: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.J Nutr.(2020-May-01)
    107. Insulin - Pal S, Ellis V, Dhaliwal SEffects of whey protein isolate on body composition, lipids, insulin and glucose in overweight and obese individualsBr J Nutr.(2010 Sep)
    108. Insulin - .(2024-06-15)
    109. Insulin - Mirmiran P, Fazeli MR, Asghari G, Shafiee A, Azizi FEffect of pomegranate seed oil on hyperlipidaemic subjects: a double-blind placebo-controlled clinical trialBr J Nutr.(2010 Aug)
    110. TNF-Alpha - Asghari G, Sheikholeslami S, Mirmiran P, Chary A, Hedayati M, Shafiee A, Azizi FEffect of pomegranate seed oil on serum TNF-α level in dyslipidemic patientsInt J Food Sci Nutr.(2012 May)
    111. Insulin - Alireza Ostadrahimi, Akbar Taghizadeh, Majid Mobasseri, Nazila Farrin, Laleh Payahoo, Zahra Beyramalipoor Gheshlaghi, Morteza VahedjabbariEffect of probiotic fermented milk (kefir) on glycemic control and lipid profile in type 2 diabetic patients: a randomized double-blind placebo-controlled clinical trialIran J Public Health.(2015 Feb)
    112. High-density lipoprotein (HDL) - Marie-Pierre St-Onge, Edward R Farnworth, Tony Savard, Denise Chabot, Akier Mafu, Peter J H JonesKefir consumption does not alter plasma lipid levels or cholesterol fractional synthesis rates relative to milk in hyperlipidemic men: a randomized controlled trial [ISRCTN10820810]BMC Complement Altern Med.(2002)
    113. Insulin - Khorasanian AS, Fateh ST, Gholami F, Rasaei N, Gerami H, Khayyatzadeh SS, Shiraseb F, Asbaghi OThe effects of hesperidin supplementation on cardiovascular risk factors in adults: a systematic review and dose-response meta-analysis.Front Nutr.(2023)
    114. Weight - Demonty I, Lin Y, Zebregs YE, Vermeer MA, van der Knaap HC, Jäkel M, Trautwein EAThe citrus flavonoids hesperidin and naringin do not affect serum cholesterol in moderately hypercholesterolemic men and womenJ Nutr.(2010 Sep)
    115. High-density lipoprotein (HDL) - Miwa Y, Yamada M, Sunayama T, Mitsuzumi H, Tsuzaki Y, Chaen H, Mishima Y, Kibata MEffects of glucosyl hesperidin on serum lipids in hyperlipidemic subjects: preferential reduction in elevated serum triglyceride levelJ Nutr Sci Vitaminol (Tokyo).(2004 Jun)
    116. High-density lipoprotein (HDL) - Miwa Y, Mitsuzumi H, Sunayama T, Yamada M, Okada K, Kubota M, Chaen H, Mishima Y, Kibata MGlucosyl hesperidin lowers serum triglyceride level in hypertriglyceridemic subjects through the improvement of very low-density lipoprotein metabolic abnormalityJ Nutr Sci Vitaminol (Tokyo).(2005 Dec)
    117. Insulin - Zou Y, Liao D, Huang H, Li T, Chi HA systematic review and meta-analysis of beta-glucan consumption on glycemic control in hypercholesterolemic individuals.Int J Food Sci Nutr.(2015)
    118. Insulin - Mousavi SM, Beatriz Pizarro A, Akhgarjand C, Bagheri A, Persad E, Karimi E, Wong A, Jayedi AThe effects of Anethum graveolens (dill) supplementation on lipid profile and glycemic control: a systematic review and meta-analysis of randomized controlled trials.Crit Rev Food Sci Nutr.(2022)
    119. High-density lipoprotein (HDL) - Kojuri J, Vosoughi AR, Akrami MEffects of anethum graveolens and garlic on lipid profile in hyperlipidemic patientsLipids Health Dis.(2007 Mar 1)
    120. Total cholesterol - Sonia Blanco Mejia, Mark Messina, Siying S Li, Effie Viguiliouk, Laura Chiavaroli, Tauseef A Khan, Korbua Srichaikul, Arash Mirrahimi, John L Sievenpiper, Penny Kris-Etherton, David J A JenkinsA Meta-Analysis of 46 Studies Identified by the FDA Demonstrates That Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in AdultsJ Nutr.(2019 Jun 1)
    121. Apolipoprotein A - Chedraui P, San Miguel G, Hidalgo L, Morocho N, Ross SEffect of Trifolium pratense-derived isoflavones on the lipid profile of postmenopausal women with increased body mass indexGynecol Endocrinol.(2008 Nov)
    122. Weight - Howes JB, Sullivan D, Lai N, Nestel P, Pomeroy S, West L, Eden JA, Howes LGThe effects of dietary supplementation with isoflavones from red clover on the lipoprotein profiles of post menopausal women with mild to moderate hypercholesterolaemiaAtherosclerosis.(2000 Sep)
    123. Weight - Terzic MM, Dotlic J, Maricic S, Mihailovic T, Tosic-Race BInfluence of red clover-derived isoflavones on serum lipid profile in postmenopausal womenJ Obstet Gynaecol Res.(2009 Dec)
    124. High-density lipoprotein (HDL) - Nestel P, Cehun M, Chronopoulos A, DaSilva L, Teede H, McGrath BA biochanin-enriched isoflavone from red clover lowers LDL cholesterol in menEur J Clin Nutr.(2004 Mar)
    125. Apolipoprotein A - Jones ML, Martoni CJ, Prakash SCholesterol lowering and inhibition of sterol absorption by Lactobacillus reuteri NCIMB 30242: a randomized controlled trialEur J Clin Nutr.(2012 Nov)
    126. High-density lipoprotein (HDL) - Jones ML, Martoni CJ, Parent M, Prakash SCholesterol-lowering efficacy of a microencapsulated bile salt hydrolase-active Lactobacillus reuteri NCIMB 30242 yoghurt formulation in hypercholesterolaemic adultsBr J Nutr.(2012 May)
    127. Plasma Vitamin D - Jones ML, Martoni CJ, Prakash SOral supplementation with probiotic L. reuteri NCIMB 30242 increases mean circulating 25-hydroxyvitamin D: a post hoc analysis of a randomized controlled trialJ Clin Endocrinol Metab.(2013 Jul)
    128. Apolipoprotein A - Schwab U, Alfthan G, Aro A, Uusitupa MLong-term effect of betaine on risk factors associated with the metabolic syndrome in healthy subjectsEur J Clin Nutr.(2011 Jan)
    129. Weight - Zittermann A, Frisch S, Berthold HK, Götting C, Kuhn J, Kleesiek K, Stehle P, Koertke H, Koerfer RVitamin D supplementation enhances the beneficial effects of weight loss on cardiovascular disease risk markersAm J Clin Nutr.(2009 May)
    130. Weight - Chu TT, Benzie IF, Lam CW, Fok BS, Lee KK, Tomlinson BStudy of potential cardioprotective effects of Ganoderma lucidum (Lingzhi): results of a controlled human intervention trialBr J Nutr.(2012 Apr)
    131. Weight - Lin Guan, Peng MiaoThe effects of taurine supplementation on obesity, blood pressure and lipid profile: A meta-analysis of randomized controlled trialsEur J Pharmacol.(2020 Oct 15)
    132. Weight - Fredriksen J, Ueland T, Dyrøy E, Halvorsen B, Melby K, Melbye L, Skalhegg BS, Bohov P, Skorve J, Berge RK, Aukrust P, Frøland SSLipid-lowering and anti-inflammatory effects of tetradecylthioacetic acid in HIV-infected patients on highly active antiretroviral therapyEur J Clin Invest.(2004 Oct)
    133. Total cholesterol - Morken T, Bohov P, Skorve J, Ulvik R, Aukrust P, Berge RK, Livden JKAnti-inflammatory and hypolipidemic effects of the modified fatty acid tetradecylthioacetic acid in psoriasis--a pilot studyScand J Clin Lab Invest.(2011 Jul)
    134. Weight - Riche DM, Riche KD, Blackshear CT, McEwen CL, Sherman JJ, Wofford MR, Griswold MEPterostilbene on metabolic parameters: a randomized, double-blind, and placebo-controlled trialEvid Based Complement Alternat Med.(2014)
    135. Weight - Boozer CN, Daly PA, Homel P, Solomon JL, Blanchard D, Nasser JA, Strauss R, Meredith THerbal ephedra/caffeine for weight loss: a 6-month randomized safety and efficacy trialInt J Obes Relat Metab Disord.(2002 May)
    136. Weight - Stanko RT, Reynolds HR, Hoyson R, Janosky JE, Wolf RPyruvate supplementation of a low-cholesterol, low-fat diet: effects on plasma lipid concentrations and body composition in hyperlipidemic patientsAm J Clin Nutr.(1994 Feb)
    137. High-density lipoprotein (HDL) - Stanko RT, Reynolds HR, Lonchar KD, Arch JEPlasma lipid concentrations in hyperlipidemic patients consuming a high-fat diet supplemented with pyruvate for 6 wkAm J Clin Nutr.(1992 Nov)
    138. Weight - Hana Kahleova, Kitt Falk Petersen, Gerald I Shulman, Jihad Alwarith, Emilie Rembert, Andrea Tura, Martin Hill, Richard Holubkov, Neal D BarnardEffect of a Low-Fat Vegan Diet on Body Weight, Insulin Sensitivity, Postprandial Metabolism, and Intramyocellular and Hepatocellular Lipid Levels in Overweight Adults: A Randomized Clinical TrialJAMA Netw Open.(2020 Nov 2)
    139. High-density lipoprotein (HDL) - Ann-Charlotte Elkan, Beatrice Sjöberg, Björn Kolsrud, Bo Ringertz, Ingiäld Hafström, Johan FrostegårdGluten-free vegan diet induces decreased LDL and oxidized LDL levels and raised atheroprotective natural antibodies against phosphorylcholine in patients with rheumatoid arthritis: a randomized studyArthritis Res Ther.(2008)
    140. Apolipoprotein B - Li SS, Blanco Mejia S, Lytvyn L, Stewart SE, Viguiliouk E, Ha V, de Souza RJ, Leiter LA, Kendall CWC, Jenkins DJA, Sievenpiper JLEffect of Plant Protein on Blood Lipids: A Systematic Review and Meta-Analysis of Randomized Controlled TrialsJ Am Heart Assoc.(2017 Dec 20)
    141. Blood Pressure - Michael Macknin, Tammie Kong, Adam Weier, Sarah Worley, Anne S Tang, Naim Alkhouri, Mladen GolubicPlant-based, no-added-fat or American Heart Association diets: impact on cardiovascular risk in obese children with hypercholesterolemia and their parentsJ Pediatr.(2015 Apr)
    142. Blood Pressure - Richard J Bloomer, Trint A Gunnels, JohnHenry M SchrieferComparison of a Restricted and Unrestricted Vegan Diet Plan with a Restricted Omnivorous Diet Plan on Health-Specific MeasuresHealthcare (Basel).(2015 Jul 14)
    143. High-density lipoprotein (HDL) - Kassis AN, Jones PJLack of cholesterol-lowering efficacy of Cuban sugar cane policosanols in hypercholesterolemic personsAm J Clin Nutr.(2006 Nov)
    144. High-density lipoprotein (HDL) - Backes JM, Gibson CA, Ruisinger JF, Moriarty PMModified-policosanol does not reduce plasma lipoproteins in hyperlipidemic patients when used alone or in combination with statin therapyLipids.(2011 Oct)
    145. High-density lipoprotein (HDL) - Castaño G, Más R, Fernández JC, Fernández L, Illnait J, López EEffects of policosanol on older patients with hypertension and type II hypercholesterolaemiaDrugs R D.(2002)
    146. High-density lipoprotein (HDL) - Castaño G, Más R, Fernández JC, Illnait J, Fernández L, Alvarez EEffects of policosanol in older patients with type II hypercholesterolemia and high coronary riskJ Gerontol A Biol Sci Med Sci.(2001 Mar)
    147. High-density lipoprotein (HDL) - Dulin MF, Hatcher LF, Sasser HC, Barringer TAPolicosanol is ineffective in the treatment of hypercholesterolemia: a randomized controlled trialAm J Clin Nutr.(2006 Dec)
    148. High-density lipoprotein (HDL) - Francini-Pesenti F, Beltramolli D, Dall'acqua S, Brocadello FEffect of sugar cane policosanol on lipid profile in primary hypercholesterolemiaPhytother Res.(2008 Mar)
    149. High-density lipoprotein (HDL) - Mirkin A, Mas R, Martinto M, Boccanera R, Robertis A, Poudes R, Fuster A, Lastreto E, Yañez M, Irico G, McCook B, Farré AEfficacy and tolerability of policosanol in hypercholesterolemic postmenopausal womenInt J Clin Pharmacol Res.(2001)
    150. High-density lipoprotein (HDL) - Cubeddu LX, Cubeddu RJ, Heimowitz T, Restrepo B, Lamas GA, Weinberg GBComparative lipid-lowering effects of policosanol and atorvastatin: a randomized, parallel, double-blind, placebo-controlled trialAm Heart J.(2006 Nov)
    151. Blood Flow - Reiner Z, Tedeschi-Reiner ERice policosanol does not have any effects on blood coagulation factors in hypercholesterolemic patientsColl Antropol.(2007 Dec)
    152. LDL Oxidation - Kassis AN, Kubow S, Jones PJSugar cane policosanols do not reduce LDL oxidation in hypercholesterolemic individualsLipids.(2009 May)
    153. High-density lipoprotein (HDL) - Ried K, Toben C, Fakler PEffect of garlic on serum lipids: an updated meta-analysisNutr Rev.(2013 May)
    154. High-density lipoprotein (HDL) - Adler AJ, Holub BJEffect of garlic and fish-oil supplementation on serum lipid and lipoprotein concentrations in hypercholesterolemic menAm J Clin Nutr.(1997 Feb)
    155. High-density lipoprotein (HDL) - Budoff MJ, Takasu J, Flores FR, Niihara Y, Lu B, Lau BH, Rosen RT, Amagase HInhibiting progression of coronary calcification using Aged Garlic Extract in patients receiving statin therapy: a preliminary studyPrev Med.(2004 Nov)
    156. High-density lipoprotein (HDL) - Sobenin IA, Andrianova IV, Demidova ON, Gorchakova T, Orekhov ANLipid-lowering effects of time-released garlic powder tablets in double-blinded placebo-controlled randomized studyJ Atheroscler Thromb.(2008 Dec)
    157. High-density lipoprotein (HDL) - Steiner M, Khan AH, Holbert D, Lin RIA double-blind crossover study in moderately hypercholesterolemic men that compared the effect of aged garlic extract and placebo administration on blood lipidsAm J Clin Nutr.(1996 Dec)
    158. High-density lipoprotein (HDL) - Simons LA, Balasubramaniam S, von Konigsmark M, Parfitt A, Simons J, Peters WOn the effect of garlic on plasma lipids and lipoproteins in mild hypercholesterolaemiaAtherosclerosis.(1995 Mar)
    159. High-density lipoprotein (HDL) - Phelps S, Harris WSGarlic supplementation and lipoprotein oxidation susceptibilityLipids.(1993 May)
    160. High-density lipoprotein (HDL) - Sobenin IA, Pryanishnikov VV, Kunnova LM, Rabinovich YA, Martirosyan DM, Orekhov ANThe effects of time-released garlic powder tablets on multifunctional cardiovascular risk in patients with coronary artery diseaseLipids Health Dis.(2010 Oct 19)
    161. Total cholesterol - Warshafsky S, Kamer RS, Sivak SLEffect of garlic on total serum cholesterol. A meta-analysisAnn Intern Med.(1993 Oct 1)
    162. Total cholesterol - Stevinson C, Pittler MH, Ernst EGarlic for treating hypercholesterolemia. A meta-analysis of randomized clinical trialsAnn Intern Med.(2000 Sep 19)
    163. Total cholesterol - Mader FHTreatment of hyperlipidaemia with garlic-powder tablets. Evidence from the German Association of General Practitioners' multicentric placebo-controlled double-blind studyArzneimittelforschung.(1990 Oct)
    164. High-density lipoprotein (HDL) - Magyar K, Halmosi R, Palfi A, Feher G, Czopf L, Fulop A, Battyany I, Sumegi B, Toth K, Szabados ECardioprotection by resveratrol: A human clinical trial in patients with stable coronary artery diseaseClin Hemorheol Microcirc.(2012 Jan 1)
    165. TNF-Alpha - Melodi Omraninava, Bahman Razi, Saeed Aslani, Danyal Imani, Tannaz Jamialahmadi, Amirhossein SahebkarEffect of resveratrol on inflammatory cytokines: A meta-analysis of randomized controlled trialsEur J Pharmacol.(2021 Oct 5)
    166. High-density lipoprotein (HDL) - Minggang Wei, Peihua Xiong, Ling Zhang, Mei Fei, Aiping Chen, Fengling LiPerilla oil and exercise decrease expressions of tumor necrosis factor-alpha, plasminogen activator inhibitor-1 and highly sensitive C-reactive protein in patients with hyperlipidemiaJ Tradit Chin Med.(2013 Apr)
    167. High-density lipoprotein (HDL) - Szapary PO, Wolfe ML, Bloedon LT, Cucchiara AJ, DerMarderosian AH, Cirigliano MD, Rader DJGuggulipid for the treatment of hypercholesterolemia: a randomized controlled trialJAMA.(2003 Aug 13)
    168. High-density lipoprotein (HDL) - Nohr LA, Rasmussen LB, Straand JResin from the mukul myrrh tree, guggul, can it be used for treating hypercholesterolemia? A randomized, controlled studyComplement Ther Med.(2009 Jan)
    169. High-density lipoprotein (HDL) - Kaul N, Kreml R, Austria JA, Richard MN, Edel AL, Dibrov E, Hirono S, Zettler ME, Pierce GNA comparison of fish oil, flaxseed oil and hempseed oil supplementation on selected parameters of cardiovascular health in healthy volunteersJ Am Coll Nutr.(2008 Feb)
    170. High-density lipoprotein (HDL) - Bunea R, El Farrah K, Deutsch LEvaluation of the effects of Neptune Krill Oil on the clinical course of hyperlipidemiaAltern Med Rev.(2004 Dec)
    171. High-density lipoprotein (HDL) - Trautwein EA, Du Y, Meynen E, Yan X, Wen Y, Wang H, Molhuizen HOPurified black tea theaflavins and theaflavins/catechin supplements did not affect serum lipids in healthy individuals with mildly to moderately elevated cholesterol concentrationsEur J Nutr.(2010 Feb)
    172. High-density lipoprotein (HDL) - Talirevic E, Jelena SQuercetin in the treatment of dyslipidemiaMed Arh.(2012)
    173. High-density lipoprotein (HDL) - Roberts LJ 2nd, Oates JA, Linton MF, Fazio S, Meador BP, Gross MD, Shyr Y, Morrow JDThe relationship between dose of vitamin E and suppression of oxidative stress in humansFree Radic Biol Med.(2007 Nov 15)
    174. High-density lipoprotein (HDL) - Kempf K, Herder C, Erlund I, Kolb H, Martin S, Carstensen M, Koenig W, Sundvall J, Bidel S, Kuha S, Tuomilehto JEffects of coffee consumption on subclinical inflammation and other risk factors for type 2 diabetes: a clinical trialAm J Clin Nutr.(2010 Apr)
    175. High-density lipoprotein (HDL) - Lee DH, Park MY, Shim BJ, Youn HJ, Hwang HJ, Shin HC, Jeon HKEffects of Ecklonia cava Polyphenol in Individuals with Hypercholesterolemia: A Pilot StudyJ Med Food.(2012 Nov)
    176. High-density lipoprotein (HDL) - Wei MY, Jacobson TAEffects of eicosapentaenoic acid versus docosahexaenoic acid on serum lipids: a systematic review and meta-analysisCurr Atheroscler Rep.(2011 Dec)
    177. High-density lipoprotein (HDL) - Blond E, Rieusset J, Alligier M, Lambert-Porcheron S, Bendridi N, Gabert L, Chetiveaux M, Debard C, Chauvin MA, Normand S, Roth H, de Gouville AC, Krempf M, Vidal H, Goudable J, Laville M, “Niacin” Study GroupNicotinic acid effects on insulin sensitivity and hepatic lipid metabolism: an in vivo to in vitro studyHorm Metab Res.(2014 Jun)
    178. High-density lipoprotein (HDL) - Sharpe SJ, Gamble GD, Sharpe DNCholesterol-lowering and blood pressure effects of immune milkAm J Clin Nutr.(1994 Apr)
    179. Total cholesterol - Golay A, Ferrara JM, Felber JP, Schneider HCholesterol-lowering effect of skim milk from immunized cows in hypercholesterolemic patientsAm J Clin Nutr.(1990 Dec)
    180. High-density lipoprotein (HDL) - Berger A, Rein D, Schäfer A, Monnard I, Gremaud G, Lambelet P, Bertoli CSimilar cholesterol-lowering properties of rice bran oil, with varied gamma-oryzanol, in mildly hypercholesterolemic menEur J Nutr.(2005 Mar)
    181. High-density lipoprotein (HDL) - Mourad AM, de Carvalho Pincinato E, Mazzola PG, Sabha M, Moriel PInfluence of soy lecithin administration on hypercholesterolemiaCholesterol.(2010)
    182. High-density lipoprotein (HDL) - Okamura S, Sawada Y, Satoh T, Sakamoto H, Saito Y, Sumino H, Takizawa T, Kogure T, Chaichantipyuth C, Higuchi Y, Ishikawa T, Sakamaki TPueraria mirifica phytoestrogens improve dyslipidemia in postmenopausal women probably by activating estrogen receptor subtypesTohoku J Exp Med.(2008 Dec)
    183. High-density lipoprotein (HDL) - Pan A, Yu D, Demark-Wahnefried W, Franco OH, Lin XMeta-analysis of the effects of flaxseed interventions on blood lipidsAm J Clin Nutr.(2009 Aug)
    184. High-density lipoprotein (HDL) - Sabet HR, Ahmadi M, Akrami M, Motamed M, Keshavarzian O, Abdollahi M, Rezaei M, Akbari HEffects of flaxseed supplementation on weight loss, lipid profiles, glucose, and high-sensitivity C-reactive protein in patients with coronary artery disease: A systematic review and meta-analysis of randomized controlled trials.Clin Cardiol.(2024-Jan)
    185. High-density lipoprotein (HDL) - Hadi A, Askarpour M, Salamat S, Ghaedi E, Symonds ME, Miraghajani MEffect of flaxseed supplementation on lipid profile: An updated systematic review and dose-response meta-analysis of sixty-two randomized controlled trials.Pharmacol Res.(2020 Feb)
    186. High-density lipoprotein (HDL) - Sadat Masjedi M, Mohammadi Pour P, Shokoohinia Y, Asgary SEffects of Flaxseed on Blood Lipids in Healthy and Dyslipidemic Subjects: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.Curr Probl Cardiol.(2022 Jul)
    187. High-density lipoprotein (HDL) - Yang NC, Chou CW, Chen CY, Hwang KL, Yang YCCombined nattokinase with red yeast rice but not nattokinase alone has potent effects on blood lipids in human subjects with hyperlipidemia.Asia Pac J Clin Nutr.(2009)
    188. High-density lipoprotein (HDL) - Zamani M, Ashtary-Larky D, Nosratabadi S, Bagheri R, Wong A, Rafiei MM, Asiabar MM, Khalili P, Asbaghi O, Davoodi SHThe effects of Gymnema Sylvestre supplementation on lipid profile, glycemic control, blood pressure, and anthropometric indices in adults: A systematic review and meta-analysis.Phytother Res.(2023-Mar)
    189. High-density lipoprotein (HDL) - Ding KX, Gao TL, Xu R, Cai J, Zhang HQ, Sun YY, Zhong F, Ma AGQuantifying the Effect of Supplementation with Algae and Its Extracts on Glycolipid Metabolism: A Meta-Analysis of Randomized Controlled Trials.Nutrients.(2020-Jun-08)
    190. High-density lipoprotein (HDL) - Fallah AA, Sarmast E, Habibian Dehkordi S, Engardeh J, Mahmoodnia L, Khaledifar A, Jafari TEffect of Chlorella supplementation on cardiovascular risk factors: A meta-analysis of randomized controlled trials.Clin Nutr.(2018-Dec)
    191. High-density lipoprotein (HDL) - Sherafati N, Bideshki MV, Behzadi M, Mobarak S, Asadi M, Sadeghi OEffect of supplementation with Chlorella vulgaris on lipid profile in adults: A systematic review and dose-response meta-analysis of randomized controlled trials.Complement Ther Med.(2022-Jun)
    192. Total cholesterol - Piotr Duchnowicz, Agmieszka Nowicka, Maria Koter-Michalak, Marlena BroncelIn vivo influence of extract from Aronia melanocarpa on the erythrocyte membranes in patients with hypercholesterolemiaMed Sci Monit.(2012 Sep)
    193. Total cholesterol - Lee E, Kolunsarka I, Kostensalo J, Ahtiainen JP, Haapala EA, Willeit P, Kunutsor SK, Laukkanen JAEffects of regular sauna bathing in conjunction with exercise on cardiovascular function: a multi-arm, randomized controlled trial.Am J Physiol Regul Integr Comp Physiol.(2022-Sep-01)
    194. Blood Pressure - Akinori Masuda, Masaaki Miyata, Takashi Kihara, Shinichi Minagoe, Chuwa TeiRepeated sauna therapy reduces urinary 8-epi-prostaglandin F(2alpha)Jpn Heart J.(2004 Mar)
    195. Glycemic Control - Gualano B, DE Salles Painneli V, Roschel H, Artioli GG, Neves M Jr, De Sá Pinto AL, Da Silva ME, Cunha MR, Otaduy MC, Leite Cda C, Ferreira JC, Pereira RM, Brum PC, Bonfá E, Lancha AH JrCreatine in type 2 diabetes: a randomized, double-blind, placebo-controlled trialMed Sci Sports Exerc.(2011 May)
    196. Blood Pressure - Perrinjaquet-Moccetti T, Busjahn A, Schmidlin C, Schmidt A, Bradl B, Aydogan CFood supplementation with an olive (Olea europaea L.) leaf extract reduces blood pressure in borderline hypertensive monozygotic twinsPhytother Res.(2008 Sep)