The Breast Cancer, High LDL Cholesterol, & Trans Fat Connection

The Skinny on Avoiding High LDL Cholesterol, Breast Cancer, & Trans Fats

Evelyn Smith, MS in Library Science, University of North Texas (2012)

Good News/Bad News

Two recent news items inspire this blog since on November 29th,  the Duke Cancer Institute announced that high cholesterol levels contribute to breast cancer, and on November 7^th,  the United States Food and Drug Administration took the first step towards completely banning artificially-manufactured trans fats, including shortening and margarine, or hydrogenated and partially-hydrogenated fats, from American food products.  Since trans fats are high in cholesterol, all this news should propel the wise to adopt a Mediterranean-style diet as well as a sensible exercise plan.  This might also mean that Southern cooks in particular might need to rethink their menus, emphasizing fresh fruits and vegetables and grilling chicken and fish instead of frying them.

This news should also propel Americans to learn exactly which foods are high in cholesterol as well as which foods contain trans fats.  At this point, they will also need to adapt their tastes, so they learn to like foods low in cholesterol.  Indeed, an evolution in eating habits will have to occur for Americans not only to trim down their waistlines but also their insurance premiums. That means ridding trans fats and high cholesterol foods from the diet, or else  be taxed (in the form of more expensive insurance policies) for the privilege of making this life-style choice.  

How cholesterol increases breast cancer. (2013, November 29).  Nature World News. Retrieved from http://www.natureworldnews.com/articles/5125/20131129/cholesterol-increases-breast-cancer-risk.htm

Researchers at the Duke Cancer Institute have found that a molecule produced by cholesterol helps breast cancer grow and spread because this small molecule mimics the estrogen hormone (How cholesterol, 2013, November 29, para. 1-2).  This finding explains why cholesterol-lowering drugs also reduce the risk of breast cancer (How cholesterol, 2013, November 29, para. 3). Previous researchers have proved that a connection exists between obesity and breast cancer, but until now, medical science hasn’t discovered how this happened (How cholesterol, 2013, November 29, para. 4).  Thus, when the Duke researchers gave the mice anti-estrogen drugs, this stopped the spread of breast cancer (How cholesterol, 2013, November 29, para. 5). Women, therefore, can reduce their risk of both breast cancer and cardiovascular disease by maintaining a healthy weight, keeping to a low-cholesterol diet, and exercising (How cholesterol, 2013, November 29, para. 6). 

Now for a summary of the abstract of the actual published report:

Nelson, Erik R., et al.  (2013, November 29). 27-Hydroxycholestrol links hypercholesterolemia and breast cancer pathophysiology.  Science, 342: 162, pp. 1094-1098. doi: 10.1126/science.1241908.  Retrieved from http://www.sciencemag.org/content/342/6162/1094

A specific molecule, of cholesterol, 27-hydroxycholesterol (27HC), promotes tumor growth and the spread of breast cancer from the breasts to other parts of the body in mice by serving as a chemical that binds to a protein embedded in a cell that triggers an estrogen response.  Thus, lowering cholesterol levels or interfering with the conversion of cholesterol to 27HC may help prevent and/or treat breast cancer.

Now for the Cure

Cholesterol: Top 5 foods to lower your numbers.  (2013). Mayo Clinic.  Retrieved from http://www.mayoclinic.com/health/cholesterol/CL00002/

Tweaking your diet as well as exercising may help lower cholesterol: 

Oatmeal, oat bran, and high-fiber foods:  The soluble fiber in oatmeal reduces low-density lipoprotein, or high cholesterol, so eating a serving of oatmeal provides about six grams of fiber, and if the dieter tops the cereal with bananas, this adds four more grams of gram. Foods like kidney beans, apples, pears, barley, and prunes also contain soluble fiber (Cholesterol, 2013, p. 1). 

Fish and omega-3 fatty acids:  Regularly eating fish rich in Omega-3 fatty acids reduces blood pressure and the risk of developing blood clots.  It also reduces the risk of sudden death in those patients who have already suffered from a heart attack.  The American Heart Association recommends eating at least two servings of grilled or baked fish high in omega-3 a week (mackerel, lake trout, herring, sardines, Albacore tuna, salmon, and halibut).  Those who don’t like fish can take a fish-oil supplement, but this won’t help them receive some other nutrients that they need like selenium (Cholesterol, 2013, p. 1).

Walnuts, almonds, and other nuts:  High in polyunsaturated fatty acids, walnuts, almonds, and other nuts can help reduce LDL cholesterol. Thus, eating a handful of unsalted almonds, hazelnuts, peanuts, pecans, pine nuts, pistachios, or walnuts may reduce heart disease.  Since nuts are high in calories, that doesn’t mean that a pecan pie or chocolate-covered pecans make for a healthy snack, but go-ahead and add a small serving of nuts instead of cheese or meat to a salad (Cholesterol, 2013, p. 1).

Extra-virgin olive oil: Olive oil’s antioxidants can lower “bad” cholesterol. To add olive oil to the diet, sauté vegetable in it, mix it with vinegar in a salad, baste meat with it, or use it as a dip for bread.  However, since olive oil in high in calories, consume only about two tablespoons per day (Cholesterol, 2013, p. 2).

Foods with added plant sterols or stanols† [for use only by those already diagnosed with high cholesterol]:  Some brands of margarine, orange juice and yogurt drinks have added plant sterols that may help reduce LDL cholesterol by ten percent (Cholesterol, 2013, p. 2).

†Warning: Such products should only be used by individuals who have high cholesterol: http://www.nutraingredients.com/Regulation/EU-slaps-plant-sterol-stanol-products-with-warning-from-2014

The Mayo Clinic also counsels that these foods can only lower cholesterol if the dieter also makes other changes in diet and lifestyle, cutting back on high cholesterol foods and total fats like meat, full-dairy products, and oils, trans fats found in margarine and store-bought cookies crackers, and cakes, exercising daily, not smoking, and keeping a healthy weight (Cholesterol, 2013, p. 2).

Freeman, David. (2011). 11 Tips to cut your cholesterol fast: Got high cholesterol? Learn what you can do to lower it quickly -- starting today. WebMD, pp. 1-3. Retrieved from http://www.webmd.com/ahrq/11-tips-to-cut-your-cholesterol-fast?page=1

Because cholesterol levels rise with age, everyone over 20 should have his or her cholesterol checked every five years (Freeman, 2011, p. 1).  Most individuals can lower their cholesterol significantly within six weeks with simple life-style changes—and if necessary medication (Freeman, 2011, p. 1).

1. Set a target: How much the cholesterol level needs to be lowered depends upon a patient’s personal and family history of heart disease along with other risk factors like obesity, high blood pressure, diabetes, and smoking.  Most physicians will aim for a LDL target of less than 70 if the risk is high while if the risk is moderate, they will aim for a LDL target of less than 130 (Freeman, 2011, p. 1).
2. Consider medication: If a patient’s cardiovascular risk is high, he or she may also need to take a cholesterol-lowering drug while at the same time working to get rid of other risk factors Cholesterol-lowering medicines include niacin, bile acid resins, and fibrates, but most people take statins, which can lower LDL, (or bad) cholesterol by 20 to 50 percent (Freeman, 2011, p. 1).
3. Get moving:  Regular physical exercise can lower LDL cholesterol and raise HDL (or good) cholesterol by 10 percent.  Accordingly, Robert Harrington, a professor of medicine at the Duke University School of Medicine asks his patients to take a 45-minute walk after supper.  Another solution to getting enough exercise would be to buy a pedometer and aim for 10,000 steps daily, which means daily walking around for five minutes every hour (Freeman, 2011, p. 2).
4. Avoid saturated fat: Saturated fat is what really raises cholesterol. This means switching canola oil or olive oil for vegetable oil, butter, margarine, lard, or shortening and eating fish instead of meat (Freeman, 2011, p 2).
5. Eat more fiber: Fruits and vegetables as well as whole grains perform a double duty as “heart-healthy antioxidants” and cholesterol-lowering dietary fiber, soaking up cholesterol like a sponge.  Dried beans, oats, and barley are good sources of soluble fiber (Freeman, 2011, p. 2).
6. Go fish*:  Fish and fish oil contain cholesterol-lowering omega-3 fatty acids. If a patient is taking an anti-clotting medication, however, he or she should check with the doctor before taking a fish or krill-oil supplement.  Try to eat servings of omega-3 rich fish, like salmon or tuna, three times a week.  Omega 3 protein also comes from soybeans, canola, flax seeds, and walnuts (Freeman, 2011, p. 2).  
7. Drink up: One drink of alcohol a day for women and up to two drinks a day for men can raise “good cholesterol by 10 percent. However, this isn’t a license to drink (Freeman, 2011, p. 3).
8. Drink green:  Green tea contains compounds that help lower LDL cholesterol (Freeman, 2011, p. 3).
9. Eat nuts:  Although nuts are high in calories, regularly eating walnuts and almonds can modestly reduce cholesterol (Freeman, 2011, p. 3).
10. Switch spreads:  Use a “margarine-spread” that contains stanols (Freeman, 2011, p. 3). To avoid the consumption of trans fats, look for healthy substitutes for mayonnaise like olive oil, mustard, salsa, roasted garlic, and just a little bit of avocado since it is high in calories. Meanwhile, consider buying produce labeled “100 organic”.
11. Don’t smoke:  Smoking lowers “good” cholesterol and thus is a major risk factor for heart disease (Freeman, 2011, p. 3).  

* Poach, steam, broil, microwave, or bake fish instead of frying it:

*For healthy ways to cook, see the following links:

• http://allrecipes.com/howto/healthful-ways-to-cook-fish/

• http://www.southbeachdiet.com/diet/how-to-cook-fish

• http://www.shape.com/healthy-eating/cooking-ideas/5-healthiest-wayscook

15 tips for lowering your cholesterol naturally. (2009). Harvard Medical School Retrieved from http://www.health.harvard.edu/healthbeat/HB_web/15-tips-for-lowering-your-cholesterol-naturally.html

Although genes and gender contribute to the chances of heart attack and stroke, what people eat plays an important part as well.  Accordingly, the Harvard Medical School offers 15 tips for fighting cholesterol through diet (15 tips, 2009, para. 1).

1. Eat meat sparingly:  Make meat a side item instead of the major part of the meal, trim off fat and skin, avoid fatty cuts of beef, pork, and lamb, or substitute fish or skinless while poultry.  When eating out, choose the smallest portion available or a fish dish.
2. Opt for low-fat dairy product: Avoid whole milk or cream.
3. Watch the snacks:  Choose low-fat homemade popcorn, carrots, dried or fresh fruits over potato chips and candy bars and store-bought bakery products.
4. Cut down on saturated fat in cooking: Use liquid cooking oil over butter or margarine, and instead of frying, bake, broil, roast, steam or stew.  Don’t make gravy with the drippings; instead baste with wine or broth.
5. Avoid palm and coconut oils: Cook with canola, sunflower, safflower, corn, soybean, olive or peanut oil.
6. Reduce dietary cholesterol:  Limit consumption to less than 200 mg. per day.  That means no more than four egg yolks per week and limiting meat, fish, and poultry to no more than six ounces per day—a three ounce serving is about the size of a deck of playing cards.  Also, steer clear of organ eats like liver, brains, and kidneys.
7. Increase complex carbohydrates and fiber:  Fruits and vegetables, whole-grain, and legumes, or dried beans and peas, are low in calories and high in fiber.  The water-soluble fiber found in dishes like oatmeal can significantly lower cholesterol when it is part of a low-fat diet.
8. Eat fruits and vegetables: These foods protect the heart.  [Evelyn’s Hint: Buy fresh fruits and vegetables rather than those canned or frozen.  Take advantage of local farmers’ markets.]
9. Go for nuts:  Studies associate the consumption of [unsalted] nuts with a lower risk of heart disease; but since they have lots of calories, “go easy on them”.  [Evelyn’s Hint: Buy a package of nuts used for cooking instead of canned nuts.]
10. Add fish to your diet:  Countries with high fish consumption have a lower risk of death from all causes as well as heart disease.  Both fish and nuts contain the essential fatty acids omega-3 and omega-6 that the body doesn’t manufacture.
11. Reduce salt intake:  Diets high in salt increase the risk of high blood pressure (hypertension), and high blood pressure substantially raises the risk of cardiovascular disease. 
12. Avoid trans fat: Trans fats raise “bad” cholesterol and lower “good” cholesterol, so avoid or eat only very small qualities of food that list hydrogenated oil or partially hydrogenated oil.
13. Drink alcohol only in moderation: Heavy drinking cancels out the health benefits of moderate drinking.  Women shouldn’t drink more than one alcoholic drink per day, and men shouldn’t drink more than one or two drinks.
14. Read labels carefully:  Avoid food products that list these foods as their first ingredients: Meat fat, coconut or palm oil, cream, butter, egg or yolk solids, whole milk, hydrogenated fat, or partially-hydrogenated fat, or oil.  Eat fast foods sparingly. [Evelyn’s hint: Products labeled with a five-digit number beginning with 8 contain genetically-modified foods while products labeled with a five-digit number beginning with a 9 are organic.]
15. Change strategies [if necessary]:  If three months of eating healthy food doesn’t bring down LDL cholesterol levels, consult your physician.  If cholesterol levels are sufficiently lowered in six months, a patient with high LDL cholesterol might need to take medication.

(15 tips, 2009, para. 2-16).

Trans Fats, Genetically Modified Organisms & the Move to Certified Organic Foods

Early last month, the FDA announced that there foods prepared with trans-fat additives were unsafe, thereby taking the first step in banning trans fats, like margarine and shortening, completely.  This also means that cooks need to look at their recipes and come up with safe substitutes for these products that also have a lower cholesterol and calorie count than butter, thus continuing America’s move to a more Mediterranean diet*, replacing  butter and margarine with olive oil, for example.

Lipsky, Michael. (2013, November 30). In the FDA’s actions on trans fats, are there lessons for GMO labeling? Grist.  Retrieved from http://grist.org/food/in-the-fdas-actions-on-trans-fats-are-there-lessons-for-gmo-labeling/

The Food and Drug Administration announced on November 8, 2013, that it would no longer consider trans fats “safe”—a step that will lead to a total ban on trans fat foods (Lipsky, 2013, November 30, para. 1). Trans fat and been part of the diet for over a century, but medical science has only regarded them as unsafe for two decades; however, Americans can learn a lesson from the trans fat story (Lipsky, 2013, November 30,  para. 2).

For example, Monsanto and other “big chemical-seed companies succeeded in defeating a Washington-state referendum that would have required the labeling of genetically modified  foods, arguing no evidence exists that genetically modified organism (GMO) are unsafe (Lipsky, 2013, November 30, para. 3).

When butter became scare in World War II, margarine, which is a trans fat, became an inexpensive substitute that authorities recommend as healthier than butter.  Until the turn of the Millennium, the public believed that trans-fats were safer than other fats until research started to suggest otherwise, leading to the recommendation that the FDA require food products to list trans-fat content on their labels (Lipsky, November 30, para. 4-5).

Then in 2002, the Institute of Medicine ruled that “no safe levels of trans-fat acids” existed: and in 2006, the Food and Drug Association required companies to list trans-fat contents in their packaged foods, making eating foods containing trans-fats very much a life-style choice like smoking (Lipsky, 2013, November, para. 6). This November, the FDA has taken the first steps at banning trans-fats from the American diet (Lipsky, 2013, November 30, para. 7).

Admittedly, banning dangerous consumer products takes a long time.  For example, the U.S. Surgeon General in 1964 warned of the effects of smoking; and since 1966, each package of cigarettes has carried a warning label.  Nevertheless, it takes a life time of smoking to succumb prematurely from lung cancer, so this latest warning leaves Americans questioning what harm a diet of margarine and doughnuts has done  (Lipsky, 2013, November 30, para. 8-9).  Meanwhile, the European Union has labeled GMO foods so consumers can exercise caution (Lipsky, 2013, November 30, para. 10).

Hayes, Ashley. (2013, November 13).  Put down that doughnut: FDA takes on trans fats. CNN.  Retrieved from http://www.cnn.com/2013/11/07/health/fda-trans-fats/

“So long, margarine”: November 7, 2013, The Food and Drug Administration announced its findings that partially hydrogenated oils are no longer “generally recognized as safe”, thus taking the first bureaucratic step in banning foods with trans-fat additives (Haynes, 2013, November 8, para. 1-2). Once this process is complete, stores and restaurants can no longer legally sell foods containing partially hydrogenated oils.  Currently, desserts, microwave popcorn, frozen margarine, and coffee creamer all contain foods with trans-fat additives (Haynes, 2013, November 8, para. 3-4).

Trans fats, like margarine or shortening, form when hydrogen is added to liquid oils, turning them into solid fats.  While this process adds to a product’s shelf life and flavor, it also can raise the levels of LDL or bad cholesterol, thus increasing the risk of heart disease (Haynes, 2013, November 8, para. 5).
  

Processed foods made with partially-hydrogenated vegetable oils include crackers, cookies, snack foods, fried goods, and some baked goods (Haynes, 2013, November 8, para. 6).

Recently, American food companies have started to limit or eliminate trans fats from to their foods; for example, McDonald’s stopped cooking french fires in trans-fat oils over a decade ago; and in 2007, New York City banned partially hydrogenated-vegetable oils and spreads from restaurants.  Today, the life expectancy of New York City residents is far higher than the national average (Haynes, 2013, November 8, para. 7-10 & 12).

The level of trans fats intake in the American diet has decreased from 4.6 grams daily in 2003 to a gram perhaps because since 2005, food manufacturers have voluntarily reduced the amount of trans fat in their products by 73 percent (Haynes, 2013, November 8, para. 13-15; 17-18).  Public policies in Brazil, Costa Rica, Denmark, the Netherlands, and South Korea have similarly reduced trans fat in their food supplies (Haynes, 2013, November 8, para. 19). 

Trans fats occur naturally in milk, butter, cheese, beef, lamb, pork, chicken and is not as harmful as artificial trans fat, but hidden trans fats can be found in pancake mixes, flavored coffee creamers, microwave popcorn, pie crusts, gravy mixes, shakes or creamy drinks, buffalo or barbecue sauces, croutons, fried foods, hot chocolate, cereal (Haynes, 2013, November 8, sidebar 2 & 3).

Yokoyama, Y., Nishimura, K., & Barnard, N. D., et al. (2014, April). Vegetarian diets and blood pressure: a meta-analysis. Journal of the American Medical Association/Internal Medicine, 174(4) 577-87. doi: 10.1001/jamainternmed.2013.14547. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/24566947

Reviewing Medline and Web of Science articles published in English from 1946 to October 2013 and from 1900 to November 2013 respectively researchers found that vegetarian diets were associated with lower mean systolic blood pressure as well as diastolic blood pressure in comparison with omnivorous diets.

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Mediterranean Diet

For additional information on the Mediterranean diet, which really should be relabeled the Mediterranean lifestyle, consult the following links:

• Janis Jibrin, & Gensler, Tracy Olgeaty. (2013). Mediterranean meal plan week 1. Good Housekeeping.  Hearst Corporation.  Retrieved from http://www.goodhousekeeping.com/health/diet-plans/mediterranean-mpwl

• Mediterranean diet. (2013). Health & wellness. U.S. News & World Report.  Retrieved from http://health.usnews.com/best-diet/mediterranean-diet

• Mediterranean diet: A heart-healthy eating plan.  (2013). Nutrition and healthy eating. Mayo Clinic. Retrieved from http://www.mayoclinic.com/health/mediterranean-diet/CL00011

• Zelman, Kathleen M.  (2013). The Mediterranean diet.  Foods & recipes.  WebMD.  Retrieved from http://www.webmd.com/food-recipes/guide/the-mediterranean-diet

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Macmillian, Amanda. (2013). The 22 worst foods for trans fat.  Health.  Retrieved from

http://www.health.com/health/gallery/0,,20533295,00.html

Macmillian list the foods most likely to contain trans fats:

1. French fries: Burger King, Jack-in-the-Box, McDonald’s & Dairy Queen have removed trans fats;
2. Anything fried or battered;
3. Pies and pie crusts:  McDonald’s and Burger King have removed hydrogenated oils from their fried pies;
4. Margarine sticks: Opt for whipped, reduced-fat, or fat-free soft spreads;
5. Shortening;
6. Cake mixes 
7.  Frostings;
8. Pancakes and waffle mixes: Opt for Bisquick complete, gluten free, and heart smart mixes;
9. Fried chicken:  Unless you know a restaurant doesn’t use hydrogenated oils, steer clear;
10. Ice cream:  Read the list of ingredients;
11. Non-diary creamers;
12. Microwave popcorn (or rather its butter flavoring”);
13. Store-bought and frozen slice-and-bake cookies: Oreos, Chips Ahoy, Nilla Wafers, and Girl Scout cookies have removed the trans fats;
14. Biscuits: Burger King, McDonald’s and Popeye’s  biscuits don’t contain any trans fats;
15.  Sweet rolls: Most Cinnabon locations have removed the trans fats from their sweet rolls;
16. Breakfast sandwiches;
17. Frozen or creamy beverages;
18. Meat sticks;
19. Crackers: Read the ingredients list before looking at the nutritional label;
20. Asian crunchy noodles;
21. Canned chili:  Choose turkey instead of beef;
22. Packaged pudding.

(Macmillian, 2013, p. 1-24)

Of  course, since corporations often respond to consumer pressure, it's best to read the labels.  Also, just because a restaurant chain has removed trans fats from one item on its menu that doesn't mean that it has removed the trans fats from all items on its menu.

Zelman, Kathleen M.  (2013). Avoiding trans fats in restaurants.  WebMD.  Retrieved from

http://www.webmd.com/diet/featres/avoiding-trans-fat-in-restaurants

New York City, Chicago, Massachusetts, Connecticut, California, New Hampshire, and New Jersey have all banned trans fats while Wendy’s, Starbucks, and Disney have joined the trans-fat-free bandwagon (Zelman, 2013, p. 1). 

However, while consumers need to avoid foods containing trans fats, they also need to balance this with a healthy lifestyle.  This means exercising regularly, limiting portion sizes, and including lean meats, poultry, and cold-water fish, non-fat or low-fat dairy products, whole grains, fruits, vegetables, legumes (peas and beans), and natural plant stanols (nuts and wheat germ) in their diet (Zelman, 2013, p. 2).

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Check Out These Cookbooks

• More Healthy Homestyle Family Favorites You’ll Make Again & Again. (2000) -- Evelyn Tribole.

• The New Mayo Clinic Cookbook.  (2004) – Donald D. Hensrud & others.

• Southern Living Slim Down South Cookbook. (2013) – Carolyn O’Neil and the staff from Southern Living.

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Bottom Line:  

When shopping for groceries, read the labels and then avoid those packaged and frozen foods that contain hydrogenated fats and partially hydrogenated fats.  Also, unless a restaurant notes that certain items are trans fat free, opt for different items.   Eschew fried foods for broiling or baking, roasting, steaming, or stewing.  Favor natural ingredients over packaged and frozen foods.  

The links furnished on this Web page as well as its editorial content  represent the opinions of their authors, so they complement—not substitute—for your physician's advice.