A Reporter Eats His Way to Lower Cholesterol: Do You Need Lipitor, or Can You Do It With Food?

Topics: High Cholesterol, Vitamins and Supplements
A Reporter Eats His Way to Lower Cholesterol

The New England Journal of Medicine reports that Lipitor beat Pravachol in cholesterol-lowering. Using food to lower cholesterol is an additional, not alternative approach.

Will the 80 mg cost $276 U.S. for 90 days from drugstore.com or will it cost $338 from CVS or $162 U.S. from a Canadian pharmacy?

Or, investigate top Amazon.com diet and nutrition alternatives to cholesterol medication

In 2003, the Wall Street Journal reported Dr. La Puma patient/WSJ reporter Tom Burton’s success to lower his LDL from 169 to 114 over 9 months. Tom followed Dr. La Puma’s tailored prescription and recipes. See below for full text.

A Reporter Eats His Way To Lower Cholesterol

Growing Number of Doctors
Emphasize Diet, Not Drugs

When it comes to lowering cholesterol, “diet and exercise” is often a throwaway line from doctors. As in: “If you don’t get your cholesterol down with diet and exercise, we’ll need to put you on medication.”

But most doctors don’t really know the dietary specifics to lower cholesterol sharply, which is why the government recommends a pill called a statin for as many as 36 million people with excessively high cholesterol. Even when doctors have the knowledge about how to reduce cholesterol without medication, they generally lack the time for real dietary consultation.

That void has helped PfizerInc.’s Lipitor, the most famous statin, become the world’s top-selling drug with another statin, Merck & Co.’s Zocor, not far behind. Such drugs, which inhibit production of an enzyme instrumental in creating cholesterol, have shown excellent effects in reducing LDL, or “bad” cholesterol, and heart attack risk, and they are relatively benign. All drugs have side effects, though, and another statin, Bayer AG’s Baycol, was pulled from the market in August 2001 after causing fatal muscular illness.

Many doctors are highly skeptical that people can significantly lower their cholesterol through dietary changes and heightened exercise. But an increasing number of them are coming around to the view that such lifestyle changes may well have powerful effects, and a recent study of a high-fiber, soy-intensive diet did show impressive results in lowering LDL.


See some recipes that help to lower cholesterol, and taste good.

I have learned through powerful personal experience that people really can significantly lower their bad cholesterol (LDL) with dietary changes rather than pills. While lots of doctors will say this is nearly impossible for most people, I accomplished it through sharply increased exercise, and some fine-tuning of delectable food choices. Simply put, I used food as medicine.

My case was a quandary: I already exercised diligently, running about four miles most days. I had long ago given up red meat and most cheese. Yet my bad cholesterol last October was 169, way above my recommended high of 130 and an optimal 100. (People’s LDL goals depend on their number of risk factors such as smoking, diabetes or high blood pressure.)

While my “good” cholesterol, or HDL, was a very protective 72, the total cholesterol of 262 was way above the recommended high of 200. Some doctors were already foretelling statins in my future — a prospect I wished to avoid.

But I had little clue about how to proceed. Federal guidelines urge a diet rich in fish, whole grains, fruits and vegetables, and lean meat. But, like many people with elevated cholesterol and its related higher heart-attack risk, I had already done much of this. And my cholesterol was still out of sight.

So I enlisted a secret weapon: John LaPuma. Espousing the food-as-medicine mantra, Dr. LaPuma is an internist, professional chef and former culinary-arts professor. Today, he runs the Santa Barbara Institute for Medical Nutrition and Healthy Weight (DrJohn@CHEFClinic.com).

Actually, he enlisted me, challenging me after some e-mail correspondence on another story to try his dietary changes and write about the effort. His recommendations are based on sound principles; a recent study of a similar diet showed significant lowering of cholesterol.

A Food Diary

The first step was filling out daily logs of everything I ate, when, where and even why — for example, whether I felt hungry before eating. This exercise helps determine whether clients eat because they’re hungry or to fill a psychological need. The logs are also designed to find out how much saturated fat or trans-fat people consume, in foods such as hamburgers or many baked goods.

That wasn’t my dilemma. With red meat gone, my limited indulgences took the form of occasional cheese, or roast chicken with skin on. Many Saturday nights, my teenage children and I would enjoy our favorite customary meal: Slow-Roasted Hen, a Paul Prudhomme Cajun roast chicken, heavily spiced, accompanied by pan-roasted rosemary potatoes. Dr. LaPuma never told me to cut it out. But his message was this: More proteins each week should come from fish, beans and nuts, and less from chicken, especially with skin.

Phasing Out the Chicken

Over several weeks, I did largely phase out the roast chicken on my own. I also cut out shrimp and squid, which are high in dietary cholesterol. The secret was adding multiple terrific dishes to the weekly cycle. There was a Turkish eggplant recipe, and white beans with escarole and tomato. Foods with high soluble fiber content are especially useful in drawing cholesterol from the blood. Oatmeal (the steelcut kind at health-food stores), unrefined (not pearled) barley, recently ground flaxseed, roasted soybeans, cannellini and other beans, eggplant, whole-wheat pasta and Brussels sprouts all helped. So did the cholesterol-lowering butter substitute Benecol (another option is Take Control).

For many people, following such a regime may be more unpalatable than taking drugs. For one, a diet so high in fiber can cause digestive problems, though these are easily remedied. In addition, some of the ingredients are literally hard to swallow. I never got used to the two tablespoons of ground flaxseed that I downed each day. I usually just gagged it down the way children used to drink cod liver oil.

In January, though, my test results were disappointing. My LDL number was down only 10 points, to 159. Total cholesterol also fell 10 points, to 252. But Dr. LaPuma, noting that few major changes work within three months, was encouraging.

We intensified the campaign. Instead of three to four miles roughly five days a week, I pushed that to four to seven miles. Weight loss helps lower LDL cholesterol, and I have dropped 10 pounds over the past few months, leaving 160 pounds on my 5-foot-10 frame. Not everyone will want to run similar distances, but stepped-up exercise and lower weight can lower cholesterol.

This month, I bit the bullet and got a third blood test. Nervous about abjectly failing and having to write about it, I was relieved when my rather astonished internist in Chicago, Paul Szyperski, called and said, “What have you been doing?” My LDL was down 33% to an acceptable 114, well below our original goal of 130. Total cholesterol was 200, exactly the dividing line between acceptable and “borderline high.” (Levels of two newer blood markers linked to coronary disease, C-reactive protein and homocysteine, were also low; the C-reactive protein fell from the earlier test.) Since my protective cholesterol, HDL, was up to 75, the total number looks relatively better.

A second blood test a week later was less dramatic, but still very positive: LDL of 142 and total cholesterol of 217. Even with these latter numbers, says Dr. Szyperski, “With diet alone, I would be happy with an over 25-point decrease. It takes you potentially out of needing medicine.”

One person’s story doesn’t necessarily apply to everyone. Steven E. Nissen, medical director of Cleveland Clinic’s cardiovascular center, believes that for most people eating habits are too ingrained for a significantly changed diet to be a sustainable approach.


Check With Your Doctor

But these dietary changes may well remove the need for many people to take medicine, and lower their dependence on them for many others. Still, people should not stop using statins without consulting a doctor. To find a diet coach to help work on your cholesterol, check with a cardiologist or a dietician at an academic hospital. In general, cutting back on saturated fat, and increasing fiber and soy products will help improve a person’s cholesterol.

Apart from not spending my, and my employer’s, money on drugs, there has been another side benefit of all this: My kids actually like a lot of these dishes.

My 16-year-old daughter regularly makes steelcut oatmeal for breakfast and enjoys split pea/carrot soup with tarragon, nutmeg and barley. And my 14-year-old son’s special request for dinner this past Saturday wasn’t Slow-Roasted Hen any longer, but grilled salmon with honey-mustard marinade.

You can’t get that with a pill.

Write to Thomas M. Burton at tom.burton@wsj.com

Updated July 22, 2003

  • Melissa

    “Steven E. Nissen, medical director of Cleveland Clinic’s cardiovascular center, believes that for most people eating habits are too ingrained for a significantly changed diet to be a sustainable approach.”

    While this may be true for some – perhaps even a majority of patients too many doctors don’t even offer diet and exercise as an option. When my cholesterol hit 280 it was a shock. My cholesterol had always been on the cusp but with low risk ratios. I had been ill and gained about 30 lbs in 2 years. I still exercised regularly and like the reporter never ate red meat and restricted cheese. My dr wanted to put me on statins immediately – at 45 years old that was unacceptable to me. I asked about diet and exercise and she said it was not likely to have enough effect but she would give me a couple months and re-test.

    I went home and changed my diet nearly overnight. I researched on my own the foods that help lower cholesterol. I followed a modified fat diet – very few saturated fats and no trans fats at all – but quite a few healthy fats. In the last year and a half I have had 2 servings of almonds and an avocado nearly every day and liberally use olive oil – not a low fat diet at all. I cut out all sugar except naturally occurring in fruits and the occasional dessert made with antioxidant rich pure maple sugar.

    I am essentially vegan but I do eat Salmon and eggs every once in a while. I eat leafy greens every single day, take fish oil, mix flax seed into foods and make fresh veggie/fruit juice several times a week.

    I did not re-test for another year. I figured a year of absolutely healthy living would protect me and I did not want to test too soon and get disappointing results.

    Today a year and a half later my total cholesterol is 157 – LDL is 67 and HDL is 80. Following the diet the weight dropped off – along with help from hiking, running and regular boot camp sessions. The only new exercise was the addition of dedicated strength training workouts.

    My Doctor is amazed – she has never had a patient do what I have done. Then again she has never encouraged or coached a patient to do so – I think for the same reason Dr. Nissen gives above – she figures most people won’t do it.

    We now have a much better patient doctor relationship. She now understands I don’t want a pill – I want assistance managing my health and I am willing to do my part. I am grateful for many drugs but we take too many of them and doctors hand out too many because – yes, people want them. We need to start educating patients and making it easier for them to take responsibility for their health. With the current state of health care and sky rocketing costs it is the only sustainable option and the healthiest.

  • You’re a star, Melissa…I love your approach and am proud of you and your willingness to invest in your health.

  • Janie

    My first test for cholesterol shocked me at age 39: total was 225. I ate mostly veggies, little dairy, no meat and weighed 119 lbs. My ratio was good, with my HDL higher than my LDL, until menopause, then it flip flopped and shot up gradually, every time I was tested, until it hit 302 a couple of years ago. I changed my diet to exclude almost all dairy, all meats but salmon, and lowered my total cholesterol 40 points. Not great, but I saw diet could do it. I slipped into bad habits and again was shocked at my last test: 331 and LDL 222…higher than my total cholesterol should be. That day I went online, did my homework and set out a plan and started on it. It is not a diet, it is food for the rest of my life, unless I want to take drugs for the rest of my life. For me, probably genetically predisposed to a high cholesterol level, I have no choice. I showed my doc the plan, my food log, and we agreed to give this 4 months and see where I’m at. I’m convinced by what I’ve read, this is completely doable with diet. Wish me luck! Any downward trend will be incentive to keep at it, and convince my doctor as well. Cheers!

  • You absolutely can do it…you probably need to add flax meal, almonds or walnuts, black tea, barley…those would be my first thoughts…

  • Saj

    in 2008, my total cholesterol was 227, HDL 21, LDL 169, Triglyceride 187, and coronary diseases runs in my family. As the situation was alarming, I researcher quite a bit, made changes to my diet (basically eat oats, home made whole bread, fruits and vegetables), and also started going to the Gym.

    In 2010, my numbers improved significantly, total cholesterol was down to 173, HDL 43, LDL 137, triglyceride 100. I was so happy and thrilled.I also lost 30 lb in the process. After this moment, I stopped going to the gym, instead started working out at home, Yoga and stuff.

    Last week I did the blood work, and here are the results; total cholesterol 209, HDL, 43, LDL, 137, triglyceride, 145.
    Now this is shocking and confusing to me, seemingly I was on the right track, I did not change my lifestyle except for discontinuing with Gym, and starting workout at home. My diet is the same as before. Could someone shine some light on situation. Thank you.

  • Saj

    I made a mistake typing my 2010 numbers were total cholesterol to 173, HDL 47, LDL 106, triglyceride 100. Sorry about that.

  • I understand your concern, but I think you can improve your numbers again.
    1. Weight gain by itself often accompanies a rise in LDL. If you re-gained some of that 30#, that is part of it.
    2. HDL rises with aerobic exercise: at the gym, people tend to push themselves harder, I’ve noticed, than at home. Resistance and balance exercise (yoga) are not aerobic, and don’t have the same effect on HDL.
    3. Triglycerides rise with carb intake (including beer), and they decline with omega-3 intake. You should look at ways to reduce starch intake (whole grains and oats, unless they are steel cut oats and sprouted grain (not flour) breads) and raise your omega-3 level, perhaps from fish: get 1gram of epa+dha daily to lower your TG level.
    4. Re check your results in 6-8 weeks.
    Hope this gets you started.

  • Saj

    Great thanks Dr. LaPuma,
    I did not gain any extra weight, I weighed 135 lb, after the weight loss and now way the same.
    I do drink 2-3 bottles of wine in a week. Perhaps I was eating a lot of home made whole bread (I eat it for lunch and dinner both).
    I do take a range of supplements ranging from lecithin, omega-3 to co-enzyme Q. I was also deficient on Vit. D, a year ago, currently I am borderline on it.
    From today I have started with Gym, and have reduced consumption of bread. As you said, I will recheck the results again after 6-8 weeks.
    Many thanks again.

  • I would also consider substituting 1.5 ounces of walnuts (~15 whole) or almonds (32) instead of bread to lower LDL. Lastly, two- three bottles of wine is a lot for someone who weighs what you do. I would keep it to under two.

  • Saj

    Thank you Dr. La Puma for the help.

  • saj

    After switching to mostly plant, nut, salmon, and grain based diet for 8 weeks, I had my blood work done yesterday. The results are, total cholesterol 137 (209), HDL 37(43), LDL 84(137), triglyceride 81(145). The numbers in the parenthesis are the ones observed 8 weeks before.

    The only thing is that my HDL has decreased despite eating nuts, good oils, and aerobic exercise. I am confused about this.

    As Doctor LaPuma says, you don’t need Lipitor to control your high cholesterol, just switch to better diet and change of lifestyle! It works, at least it did for me.

  • Fran

    I am interested to see here what you think can be done with diet alone. I was wondering if my success was average or out of the ordinary. I have been on a rather strict diet since January 1, 2012 (3+ months) and I have gone from 325 to 190 as of yesterday! My HDL is 85. And I have really been feeling much better and have been enjoying the new diet immensly! I am not eating any form of meat or animal protein (i do eat limited fish and seafood), no gluten, and no milk products. I use a ton of Olive oil in my cooking and on my salads. I use chicken broth to make some recipes. I try to limit the amount of high carbs (rice & grains). My digestion has been incredible (no more heart burn at night), my elimination fantastic, I am never hungry and my mood has improved (i am taking less anti-depressant). All the females in my family have high cholesterol so I thought it would be really hard. Just want to let people know it isn’t hard and it is worth it. I was aching all over from the statins that I once took. That’s totally gone as well. My husband has been eating whatever I cook and he has lost 7lbs. I have only lost a few but intend to start working on weight loss now. I walk briskly for an hour, 3 times a week (approx 3.7 miles). YAY!

  • Fran, your success is exceptional, because you have been diligent and purposeful. That’s what it takes. Keep up the great work!

  • Fran

    Have been keeping my cholesterol down to 200 or below (from 325 highest) but I am noticing that my blood sugar levels are going up. I am usually 88 in the mornings and now it is 98. Is this happening because I am on a high carb diet? I am not even sure what is considered a high level. Do East Indians have a lot of diabetes? I’m just wondering because they eat a predominantly vegetarian diet. I think that I’d rather have high cholesterol than diabetes! Just want to make sure I am not going in that direction.

  • Emilie

    I am 31 years old and was screened for high cholesterol around my mid-20s. I’ve tried to manage it with a regular nutritionist back then but got side-tracked after a while (it almost worked though).

    When I got to 30 years old, I had gained weight and my doctor warned me he would have to put me on a drug and sent me off with a blood test. I’m really stubborn so I started running and I didn’t lose weight but at least my cardio improved drastically.

    A year later I’ve heard of a dietician in my area doing the Forks Over Knives diet and I decided to undertake the challenge. I turned vegan overnight as well as low-fat and no added sugar (except naturally occuring ones) and whole grains. I don’t eat any meat, I don’t drink any milk or eat cheese or butter. I hardly ever use any oil at all. I’m not too good with eating flax seeds but I do enjoy steel-cut oats.

    I started in mid-febuary and dropped about 120 points of total cholesterol in about 9-10 weeks. My numbers were amazingly high: I started at 364 of total cholesterol LDL 276 and HDL 88. Afer 9-10 weeks my total was 244, LDL was down at 198 and HDL at 46. I still have a long way to go but I’m hanging in there. I actually love the new lifestyle, I can eat as much as I want and I still find ways to eat homemade treats even with the low-fat and no added sugar. The hard part is being invited to someone’s place or going out to eat.

    For those trying to cut back on some of their favorite foods:
    I was scared at first with cutting out cheese completely but if I compare to my previous experience of a cholesterol lowering diet, I find that not eating cheese at all is actually easier for me than eating crappy low-fat cheese every now and then because it only reminded me of how good real cheese tasted.

  • Sajna

    Dear Sir,

    I read about your experience in reducing your cholestrol drastically, in a short span of time and I was amazed. My name is Sajna and I am a native of India. Last year , I happened to relocate to the United Arab Emirates once I got married. I am not a complete Non Vegeterian to be frank. I have only Chicken(very less), fish (less), Junk foods not much. I have avoided eating Red meat/Shark.etc since the past 10-12 years back , till date. In a span of 6months, after I relocate to Dubai, I started having chicken twice or thrice in a month, junk foods , may be once or twice in a month,but very less quantity. And to and from work, I had to walk for about 1hour daily.

    Despite of these, I had suffered from chest pain and back, within 5months time. I Ideally met a cardiologist, who advised me it was something to be careful and it might be a muscular pain. We had an ECG taken, which the doctor advised not to worry about. I am 28years old now and I am not over weight. Medium in look. I weigh about 52-52kgs. But i keep getting this chest pain and i am over tensed about it, my mom is a cardiac patient, I am not diabetec also. Can you suggest me if using cooking oil(sunflower) would higher the amount of cholestrol? which are the fruits/veg I should intake ? Is cod liver oil harmful? what kind of food shoul i use to lower cholestrol?

    My total bad cholestrol was 29units than what it normally should be…Please Help me…

  • Sajna, I am sorry to hear about your health difficulties.
    Sunflower, like all plant foods, does not contain cholesterol, and does not raise it.
    Cod liver oil is only harmful if taken in large amounts, because of the vitamin A it contains, which can increase hip fractures in men. A tablespoon daily will help with vitamin D (tho in Dubai, that may not be a concern) and with omega-3s: it raises HDL and LDL both.
    To lower your total bad cholesterol, stop eating crackers, bread, chips, rice, flour, corn products, and instead, eat nuts (almonds, walnuts) instead: you can eat almond crackers and thicken stews with almond meal…you get the idea. Continue walking daily. Add a small amount of very hardy whole grain cereal 4x or more per week: not flakes, but the actual grain: in the U.S., steel cut oats or pearled barley are often used, but you need to sit and chew it. T
    Do this for 8 weeks, and have your #s retested, and post them.

  • I love this, Emille: you are appreciating real food: IMO, truly tasting your food is a delight, and food should be a pleasure, not just fuel.
    Btw, flax seeds do not lower LDL: flax meal does. If you want to try it again, I would start with 1 teaspoon twice daily and work up to 2T twice daily over 4 weeks. It must be taken with water, and if your colon is not used to it, you can have a bowel disturbance. So go slowly, and it will add.
    I suspect that you are using starches from grains, and interestingly, these raise LDL as well: you might consider substituting foods with good fats, like nuts, for them. It should drop LDL another 10%.

  • Yes, and yes, Fran, but not because they are vegetarian! But because their diet is Westernizing. Just today in the WSJ, Coke laments that it sells, per capita, only 12 8-ounce cokes in India, as opposed to over 200 per capita in the U.S. It wants to change the former, and one of the changes, if it does, will be to increase the diabetes rate in India dramatically. You can see it from 10 years away.

    You don’t have, on the basis of these #s, diabetes or prediabetes. Prediabetes is 100-125; you are 98.

    To avoid diabetes: a. build muscle: start with resistance exercises: muscle is where insulin receptors live, and you want to have more of them. Michelle Obama can do 25 pushups, and Ellen DeGeneres can do 20. On live TV. b. try to make your weight half your height, or if you like numbers, your BMI less than 25. c. eat a little more protein, especially at breakfast, and fewer carbs, especially at night.

    Track your BS monthly if you are concerned. But if you follow these rules, you should win.
    Keep me posted.

  • Mark

    Dr. LaPluma,

    How many weeks would you estimate it takes for the body to adjust to a radical change from the standard American diet (meat, dairy, carbs, fats, etc) to a strict vegan diet with exercise, the type of program you recommend?

    In my case, I have been on a strict vegan diet for two months. I’m a 69 yr-old man. I’ve lost some weight (212 to 196 lbs) but my real goal of getting prostate cancer PSA-rising to slow down has not appeared to be affected. Thus, it occured to me that I’m being impatient, that my chemistry may not show changes for many more weeks, or months for that matter. It’s an important issue question for me right now as my “window” for starting radiation treatment is about to close.

  • I would recommend seeing an expert nutritionist to address the dietary and lifestyle measures aimed at reducing PSA. It would not be fair to you to offer advice without knowing the details. Having said that, losing 16 pounds in 2 months is a lot! But weight loss doesn’t necessarily influence PSA. I would see an expert and get the detail.

  • Mazen

    Hi doctor,

    I am a 35 yrs old male living in Dubai. I was worried about my cholesterol since it is there in my family (father, uncles & grandfather) and most of them had heart attacks and open heart surgeries.

    I tested my levels on 17-07-2012 and had a total number of 224, LDL = 146, HDL = 40 & TG = 188. (i was weighing 90 kg and i am 178 cm tall).

    Since my wife was on a protein diet, i was eating like her chicken at lunch and meat at dinner (all grilled) but i lost 5 kg from my weight and i repeated the tests on 07-11-2012 and was shocked with the results [total number of 247, LDL = 170, HDL = 44 & TG = 164…..maybe from the chicken and meat……my doctor prescribed Crestor 20 mg but i refused to take it and decided to beat my cholesterol with food.

    I stopped eating meat and chicken, not a single peace….i ate salmon (once per week), walnuts daily, vegetables, beans, avocado, olive oil…and also omega 3 capsules (1500mg daily) and i tested after like 6 weeks on 24-12-2012 and my results were total number of 227, LDL = 161, HDL = 47 & TG = 89……i was happy from the TG and the HDL result but not from the LDL as it only dropped 8 points….

    What do you think, 6 week were not enough to repeat the test (but i was anxious), is 8 points drop in LDL in 6 weeks a good sign? shall i continue? when will my results start to drop faster?

    I appreciate your detailed reply.

  • Mazen

    I forgot to say that on 24-12-2012 when i did my last test i was weighing 81kg…..but i am not doing any excerise.

  • Mazen, good for you for changing your diet, and normalizing your weight: your BMI is now 25.6, which is just slightly overweight.
    Since you have a family history of heart disease, it’s smart to act now.
    Controlling cholesterol with food is a lot about dosage.
    You need 1.5 ounces of walnuts or almonds daily; up to 2 tablespoons of ground flax meal daily; probably less olive oil; and possibly 1/4 cup dry (cooked, it expands) of a high soluble fiber whole grain, such as barley or oats (not rolled or pearled). If there are sweets or starches, such as rice or breads, I would reduce them slightly, and substitute the foods above. Finally, I would begin to exercise, using interval training, with your physician’s approval: you could start with simple walking, walk/jogging for 5 minutes daily, moving up to 15 minutes daily; and then incorporate jump rope
    https://www.verywell.com/use-a-jump-rope-for-an-inexpensive-and-portable-workout-3120582 and strength training after 6 weeks or so.
    Write me back in 6 weeks when you have your blood work tested, and let me know which changes you made and your numbers.

  • I am almost 67 and three years ago I was tested for food allergies that make my neck swell mostly on the outside and slightly on inside so not life threatening. It was very upsetting. Onions, garlic, dill,fennel, asparagus, red and green peppers, EGG YOLK, walnuts, pecans and hazelnuts. Beets and raw plums are high in iron and give me stomach cramps. For someone who loves to cook this was a major blow. So any suggestions when you say to use,salsa, bbq sauce etc. Any suggestions.June

  • June, thanks: That’s quite odd, isn’t it? It sounds like you had skin tests against specific food allergens. It’s not clear whether you had them previously, or if you tested the food itself (I might consider that, only with the consent of your physician, and in the company of an epipen and another person to monitor you). Of course, you already tested the beets and plums!
    The easy part is substitutions: here is a green salsa that will work without the chile: http://www.foodiecrush.com/2012/05/roasted-tomatillo-and-green-olive-salsa/ add half of a medium ripe avocado for a smoother texture.
    Many bbq sauces are adulterations/modifications of ketchup: try adding black vinegar or balsamic or cider vinegar, black and white pepper, and file powder, and balance the flavors.
    Thanks for your questions.

  • AMIR

    Dr. La Puma, I’ve found this blog to be very informative. Thanks so much for maintaining it! I am having some cholesterol issues which I have never had before and I am struggling to try to figure out why. I am 29, 6’2, with a 34-35 inch waist, and I weigh 163 pounds. I eat a pretty healthy diet, with lean protein, fruits and vegetables, and very little red meat. With this diet, and my weight and age, I feel as if I shouldn’t have any problems, yet my Doctor has diagnosed me with metabolic syndrome. I have pre-hypertension, high triglycerides and borderline high cholesterol. I have always been very thin (between 130-140) and within the past couple years I decided that I wanted to gain weight so that I would have a more normal BMI for my height. A couple of years ago I was 180, but I have since lost weight and am now 163. Before I gained the weight, I always had the pre-hypertension but never had any of these cholesterol issues. My cholesterol has been as high as 250, when I weighed the most, and was on Paxil, and my LDL has been as high as 150 with triglycerides of 255. My most recent labs were a cholesterol of 214, with an LDL of 138, an HDL of 43, with triglycerides of 165. Before the past couple of years, my triglycerides were 80 and my LDL was around 100. I no longer take Paxil but I do take one prescription medication, Remeron 30mg. I have taken it in the past and not had these issues, but I don’t know if things now are different. My questions are these: What do you think is the cause of my metabolic syndrome, and what, if anything, can I do about it beyond what I am already doing? Thank you in advance for your advice.

  • Amir, thanks for the detail.
    My guess is that your ethnicity is Indian or East Asian: it’s well established that there are unique clinical and biochemical abnormalities in Indians, (often metabolically obese but physically nonobese), and that the risk for CVD and diabetes is significant, at a lower bmi and younger age.
    I don’t have a good single answer for the cause of metabolic syndrome, but here are some ideas:
    a. if you drink caffeine, stop for a week; measure your blood pressures at home with a blood pressure cuff, twice daily, while sitting for at least 5 minutes, before you stop, and then through the month. Compare the trends. Note that many black teas, energy drinks and now chewing gum contain caffeine.
    b. I assume you do not smoke tobacco or anything else: if you do, that is the first choice for your pre-hypertension. Stop now.
    c. try to sleep at least 6, and preferably 7 or more hours per night: sleep deprivation is a great cause of pre-hypertension, as are high chronic stress levels (which are an independent predictor of type II diabetes in men, by the way, and unrecognized). Meditation helps, as do daily pushups.
    d. if you drink alcohol to excess: more than two drinks per day, cut back to 1 drink per day or less. A drink= 5 ounces of wine.

    a. instead of chips, crackers, breads, rice, sweets (even traditional Indian ones), and fried snacks, eat tree nuts: almonds, walnuts, hazelnuts, pistachios: the quantity is not the issue. this is probably the single most effective substitution for you. These foods all elevate triglycerides; the nuts also lower LDL by about 8%.
    b. add flax meal, up to 2T twice daily, starting with 2t once daily: to a smoothie, to omelet, to fritatta, to salad, just with a water chaser: it binds LDL and you tie it up and poop it out. Not flax seeds; flax meal. Keep in the freezer so it doesn’t turn rancid, and give yourself an automated reminder to get it out and take it.
    c. add steel cut oats or cooked whole pearled barley to breakfast (or another meal): they are both rich in beta glucan, which has recently been tested in Asian/Indians against diabetes and hyperlipidemia; you could also take a beta glucan supplement or nichi as tested, but I would try food first: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3529881/
    d. systematically add 1 green vegetable and 1 red or yellow vegetable, not battered, breaded, coated, drenched or fried or deep fried, to your lunch or dinner, every day. Potatoes and corn do not count as vegetables.
    e. if you eat/use ghee, switch to a liquid oil such as olive or sesame; and reduce the fried foods in your diet to one per week, if any.
    f. write back in a month or so after you have retested your labs.

  • Hi Dr. La Puma. Thanks so much for your reply. I am Iraqi on my father’s side and American (with European background) on my mother’s side. As for your questions, I do not drink caffeine or alcohol and I do not smoke. I sleep at least 8 hours a day and for the most part, I eat whole grains rather than processed foods. I have already started eating oatmeal for breakfast, but it hasn’t been long enough to retest and see if this change has made a difference. The main change that I have chosen to make to address this is to decrease my consumption of processed foods, because I have read that LDL and triglycerides are increased by sugar in the diet. I used to drink a lot of fruit juice and smoothies, but those are now gone. Is this a prudent change or not and is it likely to make a difference? Does this added information give you any more insight into what might be causing this problem, or what more I could do beyond what you have said, and if the cause is mostly genetic, as you seem to be suggesting, than why has this chosen to show up now when my genes have been the same my entire life?

  • Genes are not static. They make protein and watch other genes. They react to your environment by changing the proteins they make. They respond to how you eat, handle stress, sleep and work out.

  • Rose

    I have loved reading these inspirational stories. I do have one issue that I didnt see and that is that I am Gluten Intolerant. I relate to many who thought they were on the right track only to find out that their numbers were off the chart. Last year my numbers were total cholesterol of 230 and the Dr recommended a statin, which I took for a little while, but did develop side effects and really dont want to be dependent on any medications. So, in a year, I have lost 20 lbs, exercised 4-5 days a week at the gym (cardio and weight training). I basically eat very little sugar, few carbs (veggies), very little red meat,chicken breasts, and almonds. I was expecting great results when I was retested and was floored when my LDL was 176, HDL went up from 50-71, TRIG were 46 and blood sugar 83. When I looked at my diet, I was heavy on animal fats, butter, greek yogurt, cream in coffee. Not enough Omega 3’s for sure and basically no fish 🙁 ,I just dont enjoy it.
    I have now Gluten Free Oatmeal everyday, I have eliminated most dairy items, except my greek yogurt, but changed that from 2% to 0% fat. I have added Flax seed and eat an 1/2 avocado daily. I still havent found a love for fish, I do enjoy salmon, just dont like it cooked at home. I am still hoping to loose about 5 more lbs, and do exercise 5-6 days now. I will be waiting about 6 mos before being tested again. Any suggestions you have for a Gluten Free diet would be great! Thanks

  • Rose, you have an inspirational story yourself. Very powerful.
    You are doing this all the right way.
    To up this a little bit:
    a. make sure it is flax meal, not flax seed: the former is effective, the latter goes through you
    b. for many people, the high sat fats of animals, butter, yogurt, cream do raise LDL: that’s probably you. However, there is less agreement these days about whether the sat fat in and of itself means a higher risk for heart disease. I know that’s confusing. Nevertheless, because you have tried so hard, I would use olive oil or avocado instead of butter; good for you on the greek yogurt (try FAGE: amazing stuff); almond milk or light coconut milk in coffee (yes, sat fat, but lower and very good flavor);
    c. I would add nuts (almonds if you like, or another) to the oatmeal: there is not enough protein in it to keep you full thru the day, in my experience: or a hard boiled egg; or a cheese stick.
    d. if you tend to eat at night, or drink, I would look at an assortment of hot tea as an after dinner nightcap, instead of booze: the cal add up quickly with wine and beer. Black and green tea have both been tied to a lower LDL.
    e. don’t make the mistake of eating gluten-free junk: you can now get donuts, cookies, fast food pizza all gf. Not a #win.
    f. fish that doesn’t taste like fish is generally fresh, not fresh frozen: try it when it is available. See my recipe Pan Seared Halibut with Spring Vegetables (it is gf, about 8 recipes down on the page: https://www.drjohnlapuma.com/food-wine/recipes/)

  • AMIR

    Dr. La Puma, I’ve written you in the past but I am having a new problem that I’d love to get your feedback on. As I discussed earlier, I have borderline high cholesterol and high triglyceride levels. In order to try and address these things, I have dramatically cut my sugar intake, based on my own research that doing so can really the problems I have. Your own advice seemed to confirm my findings. As a result, I’ve lost a lot of weight. When I wrote you three weeks ago, I was 163 pounds, but I am now 155 pounds and dropping. A couple of years ago, I was 180 pounds. I feel like at 6’2, my weight is currently far too low. The way in which I would gain weight would be to drink Ensure Plus three times a day, which provides 1050 calories a day, which when supplemented with food, would be enough to gain weight. This, to me, is far better metabolically than loading up on fast food, ice cream, and other saturated fats. The problem with this approach is that Ensure Plus has 50 grams of sugar per serving, so 3 of these a day would require me to ingest 150 grams of sugar a day just for Ensure. I feel this would likely increase my triglycerides even further, but I really don’t know what else to do. Cardiovascular exercise may be able to help with the metabolic syndrome, but cardiovascular exercise will also likely cause me to continue to lose weight. I have added oatmeal and nuts to my diet to help address the metabolic issues, but I am still losing weight. What advice do you have for me on this problem? Do I have to make a choice between being at a healthy weight or having metabolic syndrome? What should I do?

  • jmaggief

    I got my total cholesterol results of 225, LDL 155.5, HDL 58, triglycerides 62 and my doctor suggested I go on lipitor but I keep seeing TV commercials from layers saying if you got diabetes from that call them up or another statin that caused a fatal muscle disease. For 6 months I have been eating 500 calories a day,and went from 188 lb to 161 lbs. I’m 5’5′, 61

  • disqus_VDMOBiuPfw

    You are so full of it. Your diet sucks and you should be SUED for writing that eating this crap is healthier than eating normal food. There’s no proof that it does, and if I set out to prove that it raises cholesterol, I could probably do that.
    How did we get to this point in human history with the normal food you rail against? Eating the diet you suggest would have wiped out the human race. You are a liar and a shit.

  • Ben

    “You can’t exercise your way out of poor nutrition.” I found this to be absolutely true. As an avid cyclist, I put in 10-15 hours a week on the bike, yet my cholesterol was still at an alarming 269. The last time it had been in acceptable levels, I was a vegetarian for 6 months. So, a year ago, my wife and I decided to go completely vegan. Giving up cheese was the hardest thing. I am nearly 50 years old.

    So here is the amazing thing. After a year of being completely vegan, my total cholesterol is 129. Yes, that is a drop of 139 points. My wife has a total cholesterol of 135. Obviously, diet really is the game changer.

    Going vegan is a challenge at first, but with the information available on the internet these days, keeping food new and exciting is easy. The pallet changes quiet quickly, and the food cravings change to healthy alternatives. Like I mentioned before, cheese is that hardest thing to avoid. Dairy is in everything. If you eat anything processed, you must read the ingredients and know what you are looking for.

    Another amazing benefit of the vegan diet for me is that I have ZERO arthritis now. Before we changed the way we eat, I would have days when walking was almost impossible. My knees and ankles would swell and hurt for days or weeks at a time. That is completely gone. What a blessing.

    One last encouraging note for you if you try to go vegan: Be patient with your friends and family. Our culture has ingrained in us that we are supposed to eat large amounts of meat and dairy. Just as the perception of cigarette smoking changed with time, so will the idea of what we should be eating. Good luck and blessings to you.

  • Desert Prince

    Dear Dr. La Puma.
    After reading the comments and queries below i would like to post my query and would like to get help…before that about me…28 years old Male,weighing 85kgs. recently i did my cholestrol test and the results were not at all impressive… my cholestrol was 339 … Trig 165 … HDL 38 …. LDL 268… please advice me to reduce this levels …ur help will be really appriceated. Thanks

  • Ginnis

    My numbers look a lot like this individual’s numbers. My diet is similar – albeit with less chicken. I cycle anywhere between 100-300 miles a week (rides 4-6 days, with usually one long ride thrown in), and my aerobic capacity is excellent for my age. I am currently eating 0 eggs/meat/diary but with small bits of low cholesterol cheese- other than that mostly vegan. My numbers shot up this year, and it could be hormonal (62 with the longest menopausal transition in history – still not over). I also drink a glass of red wine with dinner and maybe I should give that up. And – I am wondering about fish. Salmon with its 100-120 mg cholesterol. At present, my primary agrees with my efforts. (She knows I’m health conscious and I read JAMA – e.g., the 9-27 review). But I am wondering about fish. Maybe those suggestions are really misguided. How can I reconcile a 100 mg filet of salmon but not eat a 60 mg bit of chicken???



  • MartiniTime

    I’m not a doctor but based on my own recent cholesterol battle, I’ve done lots and lots of research. Salmon is essential for those with high cholesterol, and I’ve read that those with high cholesterol should have salmon 2x per week. Your single glass of red wine also shouldn’t be an issue but rather a benefit due to the antioxidants.

  • Matthew Cummings

    Thank you so much for posting this.