If you've been diagnosed with high or borderline-high cholesterol — almost a third of American adults have — you're probably wondering whether you should worry and if there's anything you can do about it.
The answer is yes and yes, says Suzanne Steinbaum, DO, a cardiologist in New York City and spokesperson for the American Heart Association (AHA).
Cholesterol statistics show even moderately elevated LDL levels (between 100 and 159 mg/dL) are associated with a 30 percent or greater risk of premature death from heart disease compared to those whose numbers were considered healthy (under 100 mg/dL), according to an August 2018 Circulation study.
It's not all doom and gloom, however: "The good news is your cholesterol, especially your LDL (the "bad" cholesterol) is incredibly responsive to lifestyle. So, after six weeks of healthy strategies such as eating right and exercising, you should start seeing changes," Dr. Steinbaum says. Here's how.
1. Eat Less Meat
Fad diets may be all the rage, but research suggests that most kinds of animal protein — even if it comes from sources lower in saturated fat, like pork or chicken — aren't great for your cholesterol.
When researchers looked at healthy adults between the ages of 21 and 65 and had them either eat a diet high in red meat, white meat or plant protein (such as beans and nuts) for four weeks, they observed only those in the plant protein group showed reductions in blood cholesterol, according to a June 2019 study in the American Journal of Clinical Nutrition.
Not sure how to start cutting down on meat? Try these plant-based recipes that are packed with protein.
"Plant-based proteins aren't just low in saturated fat, but they're also rich in other nutrients that help promote healthy cholesterol, such as fiber and antioxidants," explains Lauri Wright, PhD, RDN, a spokesperson for the Academy of Nutrition and Dietetics and chair of the Department of Nutrition and Dietetics at the University of North Florida.
What's more, a diet rich in soy protein (such as edamame and tofu) is linked to a 3- to 4-percent lower LDL level, a significant amount, an April 2019 review in the Journal of Nutrition found.
In general, a Mediterranean-style diet that’s rich in fruits, veggies, whole grains, low-fat dairy and healthy fats (such as those found in fatty fish, avocados, nuts and olive oil) is best for your overall heart health and cholesterol levels, Dr. Steinbaum advises.
2. Cook With Seed Oils
Olive oil is held up as the heart-healthy standard, but it isn't the only goodie for your heart. Seeds oils such as sunflower, safflower and flaxseed oil might actually be more effective at lowering LDL cholesterol, according to a large September 2018 German analysis of 54 studies published in the Journal of Lipid Research.
The research showed that safflower topped the list as far as lowering total cholesterol as well as LDL cholesterol, followed by canola oil.
Try mixing up your plant oils to reap multiple benefits: Coconut oil, for example, was most effective at boosting HDL, or "good" cholesterol levels. The big no-no, according to this study, is cooking with butter or lard. Both came in dead last when it comes to improving total and LDL cholesterol and may actually raise your cholesterol levels, according to the review.
3. Replace Saturated Fats With Unsaturated Fats
Saturated fats are found in animal products such as meat and dairy as well as tropical oils (including coconut oil and palm oil).
While these foods may be tasty, the AHA advises that people who need to lower their cholesterol cut their daily saturated fat intake to no more than 5 to 6 percent of total calories. So if you're eating 2,000 calories a day, that totals to around 11 to 13 grams of saturated fat.
"Any type of healthy fat, whether it's nuts, vegetable oils, oily seafood or avocados can all increase HDL levels and lower triglycerides compared to carbohydrates."
What's more, including more foods high in unsaturated fats (such as avocado and almonds) in your diet is linked to lowering cholesterol. When overweight people who able to incorporate a daily avocado into their diet, they were observed to have fewer small, dense LDL particles, according to an October 2019 study published in the Journal of Nutrition.
And while all LDL particles are bad, these smaller ones are especially harmful because they encourage even more plaque buildup in the arteries.
Try mashing half an avocado over your whole-wheat toast in the morning or making a healthy guacamole veggie dip.
What's more, people who ate a handful of almonds daily for six weeks were observed to have higher HDL cholesterol levels than a control group who munched on a muffin instead, according to an August 2017 Penn State study published in the Journal of Nutrition.
You can chalk these favorable effects thanks to the almonds' good-for-you-fats such as monounsaturated fats, which can help boost your HDL levels, explains study author Penny Kris-Etherton, PhD, RDN, distinguished professor of nutrition at Penn State University.
But there's another benefit: Almonds not only raised HDL levels but also improved its functioning (HDL scoops up cholesterol from your arteries and helps transport it out of your body). As a result, LDL cholesterol also decreased. The take-home message: "Any type of healthy fat, whether it's nuts, vegetable oils, oily seafood or avocados can all increase HDL levels and lower triglycerides compared to carbohydrates," Kris-Etherton explains.
4. Eat More Fiber
There are two types of fiber: soluble and insoluble fiber. But only soluble fiber can help lower cholesterol because it binds with cholesterol in the intestine and shuttles it out of the body.
In fact, eating 5 to 10 grams of soluble fiber a day can help drop your total cholesterol and LDL cholesterol levels by 5 to 11 points, according to the National Lipid Association. You can find soluble fiber in these foods.
While oats always get the spotlight for their cholesterol-lowering qualities, barley's a rising superstar, too. Eating barley or foods containing barley is linked to a reduction in LDL levels, according to a review of 14 studies published in June 2016 in the European Journal of Clinical Nutrition. Both barley and oats are rich in beta-glucan, a type of soluble fiber that can help lower cholesterol, Wright says.
Try throwing some pearled barley into your stews and soups (1/4 cup uncooked pearl barley contains about 2.5 beta-glucan), or replacing your rice at dinner with cooked barley. Another option is to use barley flour when baking or to thicken soups or sauces.
5. Exercise as Much as You Can, Whenever You Can
People who took up aerobic exercise such as jogging, running and biking for 12 weeks saw their HDL increase by 4.6 percent, their triglyceride levels fall by 3.7 percent and their LDL levels drop by 5 percent, a February 2014 review published in the journal Sports Medicine found.
"Exercise also has the benefit of increasing your HDL, which is very hard to do either through other lifestyle changes or through medications," Dr. Steinbaum explains.
The AHA recommends at least 150 minutes of moderate physical activity (think walking, gardening or tennis) a week. But to get even better results, you need to ramp it up a bit. One study cited in the Sports Medicine review, for example, found that while people who got moderate exercise (the equivalent of 12 miles of walking or jogging per week) lowered their LDL, the best results were seen in those who stepped it up a notch and jogged about 20 miles a week.
It's also important to add resistance training into the mix (the AHA recommends at least two strength-training sessions a week). Women between the ages of 30 and 60 who did two one-hour weight-training sessions a week for three months showed a reduction in total cholesterol, triglycerides and a boost to HDL cholesterol compared to a control group, according to a small March 2015 study published in Revista médica de Chile.
If you have time to add some yoga or meditation into the mix, do so. People who regularly practiced yoga had lower LDL cholesterol and higher HDL cholesterol than those who didn't say "ommm," a December 2014 meta-analysis in the European Journal of Preventative Cardiology found.
While some of these beneficial effects may be due to the physical activity involved in yoga, it may also be because it can help lower stress levels, which has also been shown to affect cholesterol, points out Ragavendra Baliga, MBBS, professor of internal medicine at Ohio State University Wexner Medical Center.
6. Quit Smoking and Boozing It Up
Lighting up a cigarette raises LDL levels and lowers HDL levels, Dr. Steinbaum stresses. The good news is once you quit, you'll see results fairly rapidly: HDL levels rose by up to 30 percent within just three weeks of quitting, a September 2013 review in the journal Biomarker Research found.
Want more incentive? Within a year, your risk of developing heart disease will have dropped to about half that of a smoker's, according to the World Health Organization.
You may have also heard that a glass (or two, or three) of red wine is good for your heart, but the key here is moderation, Dr. Steinbaum clarifies. An April 2017 study published in the American Journal of Clinical Nutrition found that moderate drinking — a half to a full drink a day for women and one to two drinks daily for men — was associated with a drop in HDL levels.
7. Lose Just a Little
Extra padding can increase bad cholesterol (LDL) and triglycerides and lower good cholesterol (HDL). This is especially true if you have belly fat.
"This type of fat is located near your portal vein, which carries blood to the liver," Dr. Steinbaum explains. "It's thought that certain chemicals secreted by visceral fat enter the portal vein and go to the liver, where they influence your body's production of blood lipids." This may help explain why folks with belly fat have higher total cholesterol and LDL and lower HDL.
The best way for you to lose weight is to follow the steps above. The good news is you don't have to lose much to see results. Losing just 5 to 10 percent of body weight led to a significant reduction in both LDL levels and triglycerides, a September 2016 study published in Translational Behavior Medicine found.
8. Consider Statins
While you can start seeing changes in your cholesterol as early as six weeks after making favorable lifestyle changes, most doctors recommend sticking to them for about four to six months before considering medication if your cholesterol is borderline high.
Statins are the main type of cholesterol-lowering drugs. Both the American College of Cardiology and AHA recommend that people who have other risk factors for heart disease — such as diabetes, high blood pressure, being overweight or a smoker — and whose ten-year risk of a heart attack is 7.5 percent or higher (you can check yours here) begin statin therapy.
What About Supplements to Lower Cholesterol?
It’s a good idea to steer clear of supplements, such as red yeast rice, that claim cholesterol-lowering benefits. While red yeast rice has been particularly touted as being as effective as statins, it also carries many of the same risks, including kidney, muscle and liver problems, Dr. Steinbaum says.
You also have no idea what you’re getting: A June 2017 study published in the European Journal of Preventive Cardiology found that amounts of the key ingredient, monacolin K, are all over the map. “It’s better to start on a statin and revisit whether or not you need to continue taking it after a couple of years, especially if you’ve already successfully implemented lifestyle strategies like losing weight and eating a healthy diet,” Dr. Steinbaum says.
- Circulation: "Long-Term Association of Low-Density Lipoprotein Cholesterol With Cardiovascular Mortality in Individuals at Low 10-Year Risk of Atherosclerotic Cardiovascular Disease"
- American Journal of Clinical Nutrition: "Effects of red meat, white meat, and nonmeat protein sources on atherogenic lipoprotein measures in the context of low compared with high saturated fat intake: a randomized controlled trial"
- The Journal of Nutrition: "A Meta-Analysis of 46 Studies Identified by the FDA Demonstrates that Soy Protein Decreases Circulating LDL and Total Cholesterol Concentrations in Adults"
- Journal of Lipid Research: "Effects of oils and solid fats on blood lipids: a systematic review and network meta-analysis"
- Journal of Nutrition: "Inclusion of Almonds in a Cholesterol-Lowering Diet Improves Plasma HDL Subspecies and Cholesterol Efflux to Serum in Normal-Weight Individuals with Elevated LDL Cholesterol"
- European Journal of Clinical Nutrition: "A systematic review and meta-analysis of randomized controlled trials of the effect of barley β-glucan on LDL-C, non-HDL-C and apoB for cardiovascular disease risk reductioni-iv"
- Journal of Nutrition: "A Moderate-Fat Diet with One Avocado per Day Increases Plasma Antioxidants and Decreases the Oxidation of Small, Dense LDL in Adults with Overweight and Obesity: A Randomized Controlled Trial"
- Sports Medicine: "Differential effects of aerobic exercise, resistance training and combined exercise modalities on cholesterol and the lipid profile: review, synthesis and recommendation"
- Revista Medica de Chile: Resistance exercise improves serum lipids in adult women
- European Journal of Preventive Cardiology: "The effectiveness of yoga in modifying risk factors for cardiovascular disease and metabolic syndrome: A systematic review and meta-analysis of randomized controlled trials."
- Biomarker Research: "The effect of quitting smoking on HDL-cholesterol - a review based on within-subject changes"
- American Journal of Clinical Nutrition: "Longitudinal study of alcohol consumption and HDL concentrations: a community-based study"
- Translational Medicine: "Effects on cardiovascular risk factors of weight losses limited to 5–10 %"
- American Heart Association: "2018 Guidelines on the Management of Blood Cholesterol"
- European Journal of Preventative Cardiology: "Variability in strength of red yeast rice supplements purchased from mainstream retailers."
- American Heart Association: "American Heart Association Recommendations for Physical Activity in Adults and Kids"
- AHA: "The Skinny on Fats"
- National Lipid Association: "Adding Soluble Fiber to Lower Your Cholesterol"