Snacks get a hearty boost

Need to lower your LDL? Try milk and cookies. Or maybe orange juice. Or tortilla chips.

Increasingly, companies are adding heart-healthy sterols, soluble fiber and omega-3s to processed foods and beverages. And these nutrients are in high demand.

Sterols and soluble fiber are recommended by the National Institutes of Health’s National Cholesterol Education Program as part of a larger plan for lowering “bad,” or LDL cholesterol. Omega-3s are catching on for -- among other things -- their ability to lower triglycerides, a fat that increases the risk of heart disease if levels are too high.

Active Living, a new fat-free milk being sold at Ralphs and Food 4 Less supermarkets in the Los Angeles area, comes with added plant sterols. Right Directions oatmeal raisin and chocolate chip cookies (sold, for now, on the Internet only) also contain sterols as well as soluble fiber. Those are just two items on a growing list of foods recently introduced that promise to get your cholesterol levels headed in the right direction -- including omega-3 enhanced Tropicana orange juice, Corazonas tortilla chips with sterols in every bag, Promise Activ SuperShots yogurt and fruit mini-drinks with sterols and Breyers Smart! yogurt with DHA, an omega-3 fatty acid.

New food processing techniques have allowed manufacturers to enhance their products with these heart-healthy nutrients without changing the food’s taste or texture, says Julie Upton, a registered dietitian with practices in New York City and San Francisco.

The nutrient trio is particularly desirable for food manufacturers because they already have Food and Drug Administration clearance to carry a health claim saying the nutrients may prevent heart disease, allowing manufacturers to instantly add that wording to containers, bags and boxes.

But, Alice, before you drink this or eat that from the supermarket wonderland, keep in mind that these aren’t magic chips, cookies and juice.

“You can’t just add these new foods to an unhealthy diet, and expect your LDL or triglycerides to suddenly plummet,” says cardiologist Dr. Karol Watson of UCLA. “That will only add calories and, ultimately, extra pounds, which brings its own risk of heart disease,” she says. “Optimum use of these new foods,” she adds, “means substituting them for other, less healthy foods you’re likely eating now.”

One might expect the nation’s heart disease and nutrition experts to scoff at tortilla chips and chocolate chip cookies as a path to lower cholesterol. Not all of them do. New and effective ideas are most welcome, says Joy Bauer, a New York- based registered dietitian who recently helped Shaquille O’Neal with his ABC reality show for overweight kids. That’s because too many Americans are still battling high cholesterol.

A recent study in the journal Women’s Health Issues found that only 55% of insured white men and 46% of insured white women who set cholesterol-lowering goals with their doctors had reached them. Insured African American men and women fared even more poorly. Worse still were the numbers for uninsured Americans.

How low do we need to go? Despite public service campaigns and incessant TV ads for cholesterol-lowering drugs, about one-third of Americans have LDL cholesterol levels that are too high by an average of about 30%, says Dr. James Howard, head of the Lipid Center at the Washington Hospital Center in Washington, D.C., and a member of the NIH panel that drew up national guidelines for cholesterol-lowering goals.

Most people could quickly drop down by taking a daily cholesterol-lowering medication known as a statin such as Lipitor or simvastatin, the generic version of Zocor, a once-blockbuster cholesterol drug that became available as a generic a few months ago.

But the cholesterol guidelines recommend immediate medication after a high cholesterol diagnosis only for people with a 20% or higher risk of having a heart attack in the next 10 years -- for example, anyone with a total cholesterol level of over 200 combined with high blood pressure. (You can calculate your own risk at www.nhlbi.nih.gov: Click on “Health Assessment Tools,” then click on “10-Year Heart Attack Risk Calculator.”)

There are several reasons why the pill recommendations aren’t broader, Howard says. For one thing, Lipitor costs about $90 per month for those without insurance. And statins do have rare but serious side effects.

And other methods of reducing cholesterol levels, such as weight loss, exercise and reducing saturated fat intake, may help prevent not only heart disease but other medical conditions such as diabetes and stroke.

It all adds up

Before you start loading up the cart with, say, Mars’ new, sterol-enriched, CocoaVia chocolate bars, pull out your iPhone, Palm Pilot or at least a pen and pencil. The foods are nutrient enhanced, not calorie-free. Do the math, Upton says, or you -- and your grocery bill -- could soon balloon.

If you haven’t been indulging in chocolate on a daily basis, she says, adding a 110-calorie CocoaVia bar a day without cutting back somewhere else would give you more than 40,000 extra calories a year -- translating to a possible weight gain of more than 10 pounds.

On the other hand, Upton says, if you regularly drink low-fat or skim milk, switching to Active Living milk every day is a perfect way to substitute and keep calories in check while adding beneficial sterols to your diet. You also shouldn’t assume that the more you eat of these nutrients, the better. Taking in more than the recommended daily dose of soluble fiber, sterols or omega-3s doesn’t get you any greater LDL- or triglyceride-lowering benefit, says Dr. Joseph Keenan, professor of medicine at the University of Minnesota who has published extensively on cholesterol lowering.

Your best bet, Upton says, if you want to use the enriched foods: First set a total daily calorie and fat upper limit. Next, factor in the new foods.

In the case of sterols, for example, the recommendation is 2 grams daily. One 8-ounce glass of Active Living milk gives you half that amount -- with no fat and 90 calories. One ounce, or 10 to 12 Corazonas salsa picante tortilla chips, gives you 20% of needed sterols for 140 calories and 7 grams of fat.

Four tablespoons of Benecol Light margarine will give you all the recommended plant sterols, but you have to factor in the fat plus the bread it’s being spread onto, unless you want to eat it straight from the tub. It might be tempting to opt for a new product, caramel-flavored Benecol Smart Chews, because they give you the daily recommended amount of plant sterols in just four chews. The chews have no fat and only 80 calories for the four.

But an added advantage to getting sterols in a food source such as milk or juice is that you’re also getting the other nutrients that milk and juice contain, Bauer says.

A useful tool: The NIH has set out specific daily amounts of plant sterols and soluble fiber in a brochure, published a year and a half ago, “Your Guide to Lowering Your Cholesterol With TLC” (therapeutic lifestyle changes). You can access it at www.nhlbi .nih.gov/health/public/heart/ chol/chol_tlc.pdf.

Soluble fiber also is an effective LDL reducer because it binds to cholesterol in the bloodstream and carries it out through the digestive system. But you’d need to really stack your diet with soluble fiber-rich foods to get the 5 to 10 grams recommended by the NIH’s cholesterol program for a 3% to 5% LDL reduction.

Even oatmeal, touted for its fiber content because it contains beta glucan (shown in many studies to effectively lower total and LDL cholesterol) only has 1 gram of soluble fiber per serving.

Two Right Direction cookies give you a whopping 8 grams -- but you’ll also add 300 calories for two oatmeal-raisin cookies and 320 for the chocolate chip kind. (Psyllium, found in laxatives such as Metamucil, contains 5 grams of soluble fiber per serving, but it’s not a great choice for people who don’t also need help staying regular.)

As for omega-3s, the FDA allowed a “qualified” health claim for these nutrients in 2004, meaning that evidence seems to show, but is not definitive, that omega-3s (EPA and DHA, that is, not ALA, another omega-3 fatty acid) may prevent heart disease. While there is no U.S. recommended daily value of omega-3s, 160 milligrams is the value recommended by several international health councils including those in Australia and New Zealand.

Canned tuna has 450 milligrams per 3-ounce serving, and fresh salmon has a whopping 1,255 milligrams for the same size portion, so take that into consideration: Some of the fortified foods have more paltry doses of omega-3s.

Tropicana Healthy Heart orange juice, for example, has 50 milligrams (and 110 calories) per serving, and new products from Omega Farms -- omega-3 fortified dairy products including yogurt, cheese and milk -- contain 75 milligrams of EPA and DHA per serving.

Omega-3s and soluble fiber offer benefits beyond cholesterol lowering, including improved retina function from the omega-3s and a possible protection against colon cancer for the soluble fiber, so foods that contain those nutrients are good choices for the whole family.

Most experts, however, suggest leaving sterols out of the food choices for children and teens because they usually don’t need to lower their cholesterol. Sterols may interfere with beta-carotene absorption, says Cyril Kendall, a cholesterol researcher from the University of Toronto. Kendall says adults who eat the sterol-enhanced foods should also be sure to regularly eat fruits rich in beta carotene such as carrots, sweet potatoes and cantaloupe.

Your best bet, as a consumer, is first to know your cholesterol numbers, Howard says. Get tested regularly, and if the numbers are too high, get your doctor’s advice on the steps to take.

“If diet changes are recommended,” Kendall says, “choose the new, enriched foods that are inherently healthy, such as milk and orange juice, rather than, say, chocolate and chips.”

Even if you only lower your cholesterol somewhat with food and fitness, the changes may be enough. And even if you’re on medication, it may allow your doctor to lower your dose.

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Here’s the goods on new cholesterol-busting foods

Companies are fortifying foods such as yogurt, cookies and tortilla chips with heart-healthy soluble fiber, plant sterols and omega-3 fatty acids. Before you bite, check nutrient, calorie and fat contents to be sure you’re getting enough of the good stuff and not too much of the bad. Some examples:

Graphic reporting by Francesca Lunzer Kritz

Los Angeles Times