Dr. John Day
Dr. Day is a cardiologist specializing in heart rhythm abnormalities at St. Mark’s Hospital in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowships in cardiology and cardiac electrophysiology at Stanford University. He is the former president of the Heart Rhythm Society and the Utah chapter of the American College of Cardiology.
Avocados Lower Cholesterol Naturally
This podcast discusses the following topics:
1. Nutritional benefits of avocados.
2. Avocados or statins to lower cholesterol.
3. The recently published study showing that avocados can significantly lower cholesterol.
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Avocados Lower Cholesterol Naturally Podcast Transcript
John: Hi. This is Doctor John Day. Welcome to the Doctor John Day show. I am so thrilled. I got Doctor Jared Bunch on the show again. So, I guess we didn’t scare you off last time.
Jared: I’m here to stay.
John: I really like this article that you just wrote at Everyday Health, and it’s called, “This High Fat Food Can Lower Your Cholesterol.” I’m looking at your stats for this article with 5,000 shares on Facebook! That’s amazing. So I guess you hit on something that really resonated with a lot of people in this article.
Jared: Yeah, we were really excited about the general flow and the sharing of the article. It really took off and was featured on the everydayhealth.com main website for about one week.
John: So I heard that you even came in ahead of Sanjay Gupta’s article.
Jared: Well, we never quite know where we are, but when it stays on the main page, that usually is a good sign that a lot of people are interested in it.
John: There is definitely an interest with 5,000 shares on Facebook and counting. Let’s dive into this article and try to learn more about avocados. I like how you started your article with the confession that if you had just one meal left in your life, that you would look for Mexican food and avocados.
Jared: Absolutely. I think we all have had that thought at one time – what would be our last meal? We had that discussion one night as residents at the Mayo Clinic. We were all sleep deprived. It was about 2:00 AM, so we were all thinking this may be our last meal anyway and mine came down to Mexican food. I have a passion for that.
John: Now does that include guacamole?
Jared: I do like fresh guacamole, and I do like peppers as well, so yes.
John: What sort of nutrient benefits are we getting from avocados?
Jared: Avocados really are on a short list of most people for a superfood. They’re filled with lutein. Lutein is a powerful antioxidant. It’s actually quite interesting. It’s been a nutrient that’s been used for eye protection. It concentrates in the eye and may protect the eye from ultraviolet light. There’s fiber in it. It’s a rich source of potassium. Most people when they think of potassium, think of potato skins, bananas, and oranges.
Few people think of avocados, but avocados, pound for pound, beat out bananas and most other food sources for potassium. They’re loaded in vitamins, including C, D, E, and K. They’re low in sodium. An avocado may only contain 2.6 miligrams of sodium and they have about 0.7 grams of protein in them. And finally, they’re also one of the food sources that contains a fair amount of zinc and so it also may help you ward off colds and some of the other things that zinc shows a protective benefit for.
John: They are also high in fiber. Considering that our daily fiber goal is 30 grams, and the average American only eats 15 grams of fiber, just one avocado almost gets you to the US daily average.
Jared: Yeah, absolutely. One normal sized avocado will almost get you there. That’s why it’s one of the superfoods that we tend to advocate.
John: Now, avocados, is similar to our last podcast together with coconuts. For years, avocados and coconuts were shunned, but now there’s a renaissance where avocados and coconuts are all the rage. What suddenly redeemed these two foods?
Jared: Well, there’s clearly a change in thought about eating and diets. And approximately 20 years ago, everything was centered around reducing fat. We found out that they may actually be a more harmful than diets that do contain healthy fats. And as they are a food source that is rich in healthy fat, avocados are one that we can consider. Just like coconuts.
John: For those in our audience who’ve been following the medical literature or even in the lay press lately, statins have really taken a beating. First, several weeks ago, there was a study that came out that the diabetes effect with statins may be much greater than we had previously anticipated. It actually reported that statins result in a 47% increase in diabetes. And then a couple of weeks ago at the American College of Cardiology meetings, there was a study from the Cleveland Clinic showing that statins may increase coronary calcifications. Based on your article, would you consider avocados an alternative to statins?
Jared: I wouldn’t call it an alternative.
John: Okay, so you’re not willing to go that far then?
Jared: Not quite yet. Lots of people can’t take statins. One of the biggest concerns with statins is an inflammatory muscle disorder called myositis and this can lead to significant muscle injury. Fortunately this is super rare.
About 10-15% of statin users will develop joint pain and muscle pain so they end up stopping these agents. In fact, in clinic today, I saw two people that, over the past two weeks, stopped their statins, because the pain was too significant to continue and they just couldn’t do what they wanted. So, lots of people are looking for alternatives. They have high cholesterol. Their doctor said, “Let’s lower your cholesterol,” and they can’t use statins – the most common drug. So they have another drug called zetia, but unfortunately that does not have the same benefits of statins. It can be used in combination with statins to some benefit, but does not have the same strength or heart protective benefits.
And so a lot of the medical community is waiting for a new class of drugs called a PCSK9 inhibitor, and those were mentioned at the recent American College of Cardiology meetings. The pharmaceutical industry has tremendous interest in finding a statin alternative. But many people have asked, “But what can I do for myself?” They exercise, they try to lose weight, they increase the fiber in their diet, and their cholesterol is still high. That’s where I wanted to introduce the avocado as a potential option.
John: At least with my patients, most would rather take an avocado than a statin drug. How effective are avocados at lowering cholesterol?
Jared: Again, that gets back to that fats. Some fats are good for you and some are bad. Polyunsaturated fats from animal products can be harmful. Monounsaturated fats from plant-based foods can be healthful. In fact, we talked previously about coconut oils and things like that which can actually lower cholesterol. We’ve had that knowledge for some time, but not necessarily studied it in a very scientific way.
That’s what was interesting about a recent study in the Journal of the American Heart Association. This is a open-access journal supported by the American Heart Association and it often has trials that focus on some of these different therapies that maybe of interest. And this was a study that looked specifically at the potential benefit of avocados in people that have high cholesterol. Whenever we look at the beneficial effects of foods it’s good to go to reputable journals where we can trust the science and trust the outcomes, in trying to understand if they would give us benefit. And so this was a study of 45 people that were either overweight or obese, and had high cholesterol.
John: How high was their cholesterol in this study?
Jared: These were all people that in general had cholesterol levels over about 200.
John: And that’s total cholesterol above 200. So 45 people overweight to obese people all with a total cholesterol above 200.
Jared: Yes, and so they were randomized to take part in three diets. They actually studied these people after every diet. They would be on these diets for, I believe, five weeks. One diet was what we were talking about before, a low-fat diet.
John: So, going back to the diet of the 1980s, and 1990s.
Jared: Exactly. Kind of when I was growing up with my family, my mom wanted everything without fats.
John: Did you have those SnackWells fat-free cookies?
Jared: Oh yes [laughter]. There’s nothing snack well about them.
John: And the skim milk that looked like water in your cereal bowl?
Jared: Exactly. [laughter] I remember. I’m a product of the 1980s.
John: What were the other 2 diets in this study?
Jared: The other was on a moderate fat diet of healthy fats. In addition, they had one medium sized avocado a day.
John: And what about group three?
The third group was also on a moderate fat diet. Now we know that avocados have monounsaturated fats that may lower cholesterol, so the author said, “Well we need to substitute something that has some monounsaturated fat, so we can truly understand if the avocado is unique.” And so in this one, they had additional foods, such as olives, that they introduced that would provide that healthy fat content. Every single participant was on all of these diets at one point in time. After they completed one diet, they had a two-week washout period before they had to start the next diet.
John: Each person tried all three diets, then?
Jared: Yes, and the order in which they participated was random, so you wouldn’t assume that the third diet took advantage of the two diets before it.
John: So, the only difference between the second and third diet was that the second diet got an avocado a day and in the third diet they got a different type of healthy fat. What did they find?
Jared: That’s what I thought was quite interesting. The diet that contained the avocado had the greatest reduction in bad cholesterol or LDL cholesterol. In fact, the LDL cholesterol in just five weeks decreased on the average of 13.5 milligrams per deciliter.
John: Just for reference, if you start one of your patients on a statin, how much LDL reduction do you typically see?
Jared: I continue to raise the statin dose until I receive the desired level. You’ll often see reduction of about 20 mg/dL.
John: So if a patient, say, did still require statin, maybe they only require half the dose as long as they’re getting their avocado a day?
Jared: Yeah, that’s definitely a possibility. And we do know that symptoms with statins are often dose-dependent. And so one of the options physicians turn to is trying a different statin or lowering the dose and hoping that it reaches a level where the patient could tolerate it.
John: What happened with the other moderate fat diet in this study?
Jared: The other moderate-fat diet also reduce LDL cholesterol. In the moderate fat diet without avocados they were able to reduce it by on average of 8.3 mg/dL in five weeks. The low-fat diet really didn’t do a lot. In fact, we didn’t see much change in cholesterol at all. And so consuming these healthy fats actually helps lower our the bad fats in our body.
John: What does avocado do to LDL particle size and does size matter?
Jared: Size definitely matters in many things in life. The smaller and more dense your LDL particles, the worse. When I was in training, there was a lot of interest in saying, “Are all LDL particles alike? Are all good cholesterol HDL particles alike?” And so what they started to do was study them, and break them up by size and density, and that’s when a lot of insight came into fat, and how fat circulates and how it invades the vessels and inflames the vessels and causes disease. And they found these very small, dense LDL particles were the ones that could enter the vessel, enter the plaques, cause inflammation and tended to be those that were the most hazardous.
John: So when it comes to bad cholesterol, bigger is better. Is that what you’re saying?
John: And avocados will help you to grow bigger LDL particles?
Well, not as much as– they help the bigger LDL particle. The one diet out of all of them that changed the ratio of small dense particles was the avocado diet. And compared to the other moderate diets, the avocado itself had a unique property in lowering these dense particles. And so not only lowering bad cholesterol, you’re lowering preferentially the worst part of the bad cholesterol. I think that’s tremendous insight that requires a lot of additional study.
John: You bring up a good point. When we look at the cholesterol-lowering-effect of avocados, it’s modest, not quite to the level of a statin, but perhaps there’s even more bang for your avocado in that it’s not just reduction, but it also changes the nature of LDL.
Jared: Absolutely. It has a unique benefit in the treatment of cholesterol. While this is a small study it was well designed and performed.
John: Certainly in the medical world, it seems like – and many of our listeners will tell you is, one day we hear something’s bad for you, then the next day we hear that the same thing is good for you, and so we like to try to look at this as far as a trend in the right direction. In your research, has there been other work done on avocados and its effect on cholesterol and heart health?
Jared: There have been smaller studies that also show some benefit with avocados in lowering cholesterol. I hope that these smaller studies on avocados lead to a much bigger trial. You know, five weeks isn’t a long trial of any drug and we had this significant improvement in five weeks. Well, what if they continued for six months or a year? Would we see the cholesterol drop further and the dense LDL cholesterol drop further?
John: While this can’t be accepted as gospel yet, it is a great first step. I think it really gets back to what Hippocrates said, “Let food be your medicine,” and clearly there seems to be a great benefit here with avocados.
Now, at the end of your article, you mention that before we get too enthusiastic about an avocado a day, we can’t forget about the the caloric load of an avocado as well as some food allergies. Can you expand on this?
Jared: Yes. Unfortunately, a lot of the things that make avocados a superfood also make it a little bit dense in calories. An average avocado will contain about 250 calories, and so that’s not a small amount if you’re watching your weight. So you may not want to eat a lot of them even though there is some benefit, because it can cause weight gain, and weight gain can sometimes negate some of the benefits.
I went running today for five miles. When I finished my calorie counter said I’d burned 500 calories, so eating two avocados would have completely offset everything I ran off.
John: That’s a lot of exercising just to work off two avocados [laughter].
Jared: That was good guacamole.
John: Ah, so that’s how you like your avocados. Then it’s with the guac, huh?
For me it’s guacamole, yes. I need some peppers in it as well. The other interesting thing with avocados that I didn’t know is there has been some reports that in people with latex allergies, they can have similar allergic symptoms if they eat avocados. So, if you’re somebody that’s been exposed to latex and have had a severe allergic reaction it would be best to consult your doctor and maybe talk to an allergist before eating one. Obviously, if you have a latex allergy, and you’re doing fine eating avocados, continue to do so.
John: I must confess I’m not a big guac fan. I’m learning to enjoy avocados in some of our homemade salad dressings.
Jared: They are awesome in salads. They are also awesome on sandwiches.
John: Fantastic. Now this has been great, and if people want to learn more about this article or about some of the articles that you are writing, how can people find you in the Internet?
Jared: Absolutely. I’d love them to read my articles and comment, good or bad, and engage other viewers in conversation. It’s at everydayhealth.com under columns. My column is known as “Rhythm of Life.” I’m the one cardiologist there. You can also follow me on Twitter@TJaredBunch. As soon as these articles come out, I’ll send links to them so you can immediately read them through Twitter.
John: As always, Jared, it’s great to do this with you. We’ve been partners now in our cardiology practice for many years and now we’re doing these podcasts together. Thank you so much for coming on the show and sharing with us everything we always wanted to know about avocados.
Jared: My pleasure. Thanks for inviting me.
John: Thank you so much and thank you for tuning in.
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.