Issue 12: Can diet beat "bad" cholesterol? Here's what works

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Welcome to Weekly.health’s 12th issue. Every week, we explore cutting-edge research, actionable advice, and science-backed nutrition insights to help you live longer and healthier.

Our aim is to help you live another 10 healthy years and cut your risk of age-related disease.

🗒️ In This Issue:

• 📅 This Week at Weekly.health

• 🔬 Longevity Spotlight: Live longer with coffee

• 📚 Books We’re Reading Right Now

• 📈 Research Digest: What’s new in nutrition science

• 🥓 Can Diet Beat Poor Cholesterol?

• 🛍️ Things You Might Like

• ❤️ Support Weekly.health: Help us keep the research flowing

• 📘 Glossary of Terms: Definitions for technical terms in this issue

📅 This Week at Weekly.health

Because of the success of working with our sponsor, Momentous, in our last issue, we’re working with them again to offer you a 35% discount on your first purchase of creatine.

In this issue we cover recent evidence showing creatine can compliment resistance exercise to build more lean mass, as just one of the many reasons you should consider taking this evidence-backed supplement.

Please support our sponsors by taking a look at their website, as this directly supports Weekly.health to continue bringing you this newsletter. Thank you.

🔬 Longevity Spotlight: Live longer with coffee

Just one recent longevity study this week, but we think you will really enjoy this one;

Coffee linked to longer life in major US prospective cohort study:
In 43,114 US adults, drinking 1-2 cups/day was associated with ~2 extra years of life at age 50 vs none. The curve was U-shaped (more isn’t better). About 30% of the gain (0.61 years) came from fewer cardiovascular deaths over 8.7 years’ follow-up. If you like coffee, aim for 1–2 cups daily and go easy on the sugar (or omit it entirely), which blunted benefits. (source)

📚 Books We’re Reading Right Now

📈 Research Digest: What’s New in Nutrition Science

Here’s the best of recent nutrition research:

⚡ Creatine + lifting modestly improves body composition
A review of 143 trials on creatine supplementation compared those who supplemented alongside resistance training, versus those who supplemented without any additional exercise. Supplementation-only produced an increase in fat-free mass of 0.09kg - basically no meaningful gain, Supplementation alongside resistance training produced a 1.1kg gain in fat-free mass - showing that for physical fitness, creatine must be paired with resistance exercise for it to work. As we covered in last week’s issue, there are cognitive benefits to creatine supplementation regardless of exercise. To benefit, supplement 3-5 g/day of creatine monohydrate. (source)

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🧠 Smart swaps cut diabetes risk in those with prediabetes
In Finnish men (50–75) with prediabetes, a 3-year group programme shifted diets towards vegetables, wholegrains, fish and vegetable oils, and away from sausages, white bread and pastries. By year 3, a “healthy” pattern meant 33% lower type 2 diabetes risk, while “unhealthy” raised risk by 82%, especially in those with high genetic risk. Easy wins: swap butter for olive oil, choose wholegrain over refined bread, swap sausages for lean meats or fish, and swap the morning pastry for fruit and muesli. (source)

🧴 7-day fasting-mimicking diet improves metabolism
A 7-day, 850-calorie plant-based fasting-mimicking diet (FMD) improved metabolic health in healthy adults. Both low-protein/high-fat and high-protein/low-fat versions lowered fasting blood sugar (~10%), IGF-1 (a growth hormone marker, ~35%), body weight, and fat. The high-protein version went further, reducing visceral fat, boosting gut microbiome diversity, lowering triglycerides, and improving heart rate variability. In short: fasting with a tailored macronutrient mix could benefit various health goals, with high-protein going further. (source)

🥓 Can diet beat poor cholesterol?

Cholesterol gets a bad rap. The general consensus seems to be we need to lower our cholesterol levels as much as possible. But is that right, and how much can we do without medication?

Cholesterol is a waxy fat-like substance that plays a vital role in cells and hormone production, and without it we would not be able to survive . We actually produce cholesterol in the liver, so even if we eat a cholesterol-free diet, it’s still there, in small amounts.

Problems arise when too much cholesterol courses through our veins. It travels through the blood as;

Low-density Lipoprotein - LDL, the bad cholesterol

High-density Lipoprotein - HDL, the good cholesterol.

We call these good and bad because HDL actually returns excess cholesterol to the liver, which is protective. This is one reason why our aim shouldn’t be to eradicate our total cholesterol levels, and in fact we want to increase some types of cholesterol.

By contrast, LDL can deposit cholesterol in our arteries, contributing to heart disease and stroke risk. This LDL is what we typically want to reduce.

You might then consider that not all cholesterol is bad, and we want more of the good and less of the bad.

Alongside cholesterol, triglycerides are closely related, and very highly influenced by diet. High triglycerides are often a more immediate marker of poor diet than cholesterol levels, but can also indicate uncontrolled diabetes or metabolic syndrome.

When both LDL and triglycerides are high, that is a good indicator that your cholesterol may be more diet-related than genetic. High LDL by itself likely signals a genetic cause is more likely.

We won’t go into too much detail about all of the bad cholesterols, because there are actually many more than just LDL.

Improving your cholesterol - not just lowering it

Poor cholesterol levels are strongly linked to atherosclerosis - hardening of the arteries - and cardiovascular disease. Studies show that lowering LDL reduces the risk of heart disease by 20% for every ~1 mmol/L reduction. (source)

But we don’t just want to reduce the bad. We want to raise levels of good cholesterol, too.

A diagnosis for high or poor cholesterol can mean one of a few things - high LDL or total cholesterol, a poor ratio between total and HDL cholesterol, high triglycerides, or low HDL. Improving all of these markers can slow or potentially reverse the plaque build-up that leads to cardiovascular disease.

Research appears to support that benefits to cholesterol are seen with improvements in diet quality, such as eating fewer processed foods, increasing fruit, vegetable, legume, and wholegrain intake. And also with diet quantity, such as reducing calories by 500 /day and aiming for weight loss of 5-10% of total body weight.

For diet, the most impactful research we found shows;

• Low-carbohydrate diets can raise HDL levels by approximately 10% (source)

• A 500 kcal/day deficit DASH diet in those with metabolic syndrome can increase HDL by 21% for men, and 33% for women (source)

• Weight loss of 5-10% total body weight significantly benefits total and LDL cholesterol, and triglycerides. 10% almost doubled the benefit compared to 5%, and those with higher weight loss saw significantly lower cardiovascular disease risk (source)

The above research supports that for drastic improvements in cholesterol, drastic changes to your diet might be needed.

What about smaller and easier changes?

If your cholesterol levels are less than ideal, here are a few evidence-backed things you can try:

• Increase soluble fibre intake - per 5 g/day of soluble fibre, LDL reduced by roughly 5.6 mg/dL (source)

  • For 5 grams of soluble fibre: 1.25 tsbp of psyllium husk, 12 tbsp of oats, 9 tsbp of barley, 3.5 tbsp of chia seed, 5tbsp dry lentils, or 4 tbsp dry beans

• Eat nuts and seeds - 30 g/day of flaxseed (3 heaped tbsp) has been shown to produce a 10.5 mg/dL (or 8%) reduction in LDL, and significant improvements in total cholesterol and triglycerides - this is one of the most impactful dietary changes you can make (source)

• Replace saturated and trans fats with unsaturated fats - reducing red meat, dairy, and ultra-processed foods, improves the liver’s ability to clear LDL. Polyunsaturated fats from fish, seeds, nuts, vegetable oils, and monounsaturated fats from olive oil, avocado, and nuts, both tend to lower LDL when replacing saturated fat (source)

  • The key takeaway? Eat less meat (red meat, in particular), use less dairy, and eat more fish and plants. Cook and spread sandwiches with olive oil instead of butter, grill salmon instead of steak, and snack on nuts instead of cheese

• Take a high-dose of omega-3 oils - 3.4 g/day of combined EPA and DHA from fish oil has been shown to reduce plasma triglycerides by up to 50% in just one month (source)

Should you eat cholesterol-free foods?

The majority of people do not need to eat a low-cholesterol diet.

Those of us who already have poor cholesterol levels would be sensible to moderate our intake, because dietary cholesterol can increase blood cholesterol levels, and hyper-responders do exist (speak to your healthcare provider about this if your levels are very high).

But, evidence doesn’t show that dietary cholesterol really makes too much difference for the majority of people.

This is why the U.S. Dietary Guidelines Advisory Committee stated that cholesterol is “not considered a nutrient of concern for overconsumption” in a 2015 report.

Research shows that it is actually saturated fat intake that has a far greater impact on LDL cholesterol, for most people. Saturated fat reduces your ability to clear LDL from the blood. (source)

In other words, high-cholesterol foods such as eggs do not, for the majority of people, notably affect blood cholesterol levels. A McDonald’s Big Mac containing 8 g saturated fat and 85 mg cholesterol likely has much more impact on your blood cholesterol than an egg that contains just 1.6 g saturated fat yet 186 mg cholesterol (more than 2x).

Sugar-intake and consumption of refined carbohydrates can worsen triglycerides, lower HDL, and cause the liver to produce more VLDL (another lipoprotein), and so just like saturated fat, should be limited from your diet if cholesterol is a concern.

Combining high saturated fat foods with refined carbohydrates and simple sugars is a key part of the western diet we eat in the UK and USA. Starting our day with sugary cereal or pastry, eating a white bread sandwich and fried potato or chocolate at lunch, and finishing the day with a fatty burger in a white bun, drizzled with sugary sauces and paired with a sugary drink, is a recipe for cholesterol-disaster.

Can you beat cholesterol without medication?

This is a sensitive topic - unfortunately, diet can only take you so far.

While diet plays a major role in many of our cholesterol levels, genetics can play an even larger role.

Some physicians agree that “Primarily, your cholesterol profile is genetic” and while diet and lifestyle changes can produce significant benefits, it cannot override genetically-poor cholesterol levels. (source)

Genetic testing may help to identify genes causing poor cholesterol levels, and blood tests can determine if cholesterol-related risks are set in stone by your genes.

Ultimately, you should discuss with your healthcare provider if improving your diet and lifestyle will be enough to displace your need for medication. Do not assume that you can fix the problem yourself by adding flaxseed to your cereal or by exercising more - it may work for some, but not for all.

🛍️ Things You Might Like

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🙏 Thanks for Reading!

That’s the end of this issue of Weekly.health.

This newsletter is written by a small, independent team, led by James — who’s been following nutrition science for nearly 20 years and is now working towards a formal, industry-recognised qualification.

We’re based in England, so if you’re over the pond, you might notice a few strange spellings.

Our goal is to make cutting-edge, evidence-based nutrition advice simple, useful, and genuinely applicable to everyday life.

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See you next week!

📖 Glossary of Terms in This Issue (Alphabetical Order)

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