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Expert Q&A: Heart-Healthy Eating

An interview with Dean Ornish, MD.

How much can soluble fiber lower cholesterol levels? How much soluble fiber do you need to eat to get this benefit?

It depends on the individual. There is variability, and this is partly genetically determined. The best thing is to find out what works for you.

The issue is, lowering cholesterol is not just one thing. So often people are looking for a magic bullet: Oat bran is going to cure it, or Lipitor is going to cure it, or whatever. What you want to do is combine a number of different things that make a difference.

If you are eating mostly foods that are plant-based, they tend to be rich in fiber anyway. It's just that it all comes organically and naturally instead of having to add a spoonful of fiber to your food.

What are plant stanols/sterols, how do they work, and where can you find them?

These phytosterols are essential components of plant membranes. They resemble the chemical structure of cholesterol. They are present in small quantities in vegetables and fruits and nuts and berries and so on, and they lower your blood cholesterol.

They seem to work by affecting both the absorption of the food and the processing of it. Plant sterols help lower LDL cholesterol by blocking its absorption. They compete with cholesterol in the digestive tract in the formation of micelles, the tiny particles that your body uses to transport cholesterol and absorb it through the intestinal wall.

I don't want people to think, "I'll just take plant stanols and sterols and that will do it." Lowering cholesterol is a combination of several things that don't just add up but that are synergistic as well.

How will a diet rich in soluble fiber and plant stanols affect statins? Is it safe to take both?

I don't think you can get your cholesterol too low through diet and lifestyle. Cholesterol is not bad, it's just that we just get too much of it. Cholesterol is an essential building block. Because it is essential, the dietary requirement is zero because your body will always make all it needs.

It is possible you can get your cholesterol level too low through drugs. It is part of the reason why, if you can sufficiently lower your cholesterol through diet and lifestyle, it may not be just less expensive but medically more effective. Because the only side effects of diet and exercise are good ones.

When you're out having fun, do you break your own rules?

It is hard for me ever to go out to dinner without people apologizing for what they eat, or commenting on what I am eating. I don't care what you eat, that is your business. But I indulge too. My particular indulgence is chocolate.

Indulgences don't matter as much as your overall way of eating and living. If you indulge yourself one day, eat healthier the next. The language of behavior change has this moralistic quality -- I cheated on my diet because I indulged myself. I am a bad person because I ate bad food. That doesn't work, it only creates problems.

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