Veggie Blog

How to lower cholesterol through diet

Many people believe that the trend towards low cholesterol diets comes from young people dieting themselves to death, but this is not so. Keeping cholesterol levels in check is not only a matter of appearance but also of health. High cholesterol levels can cause a host of complications and diseases, including heart attack and stroke, which can even cause death.

Problems such as hypertension, heart disease and diabetes come to mind. This is especially relevant for older people and those in middle age, because cholesterol levels tend to rise with age and the body’s processes, especially digestion and the conversion of fats to energy, slow down. This is perhaps why doctors often ask older people, especially those with weight issues, to reduce the saturated fat and cholesterol they eat.

What is cholesterol?

People have been talking about cholesterol, but do they know what it is and how it affects the body? Because of the rising number of heart problems in the country, cholesterol has become a public enemy. Everybody thinks that cholesterol is bad.

Actually, not all cholesterol is bad for the body. In fact, our bodies need cholesterol to make bile salts. It is also a main ingredient in maintaining hormonal balance and in the production of vitamin D. Things become troublesome when the levels get too high and the cholesterol builds up in the arteries, making it hard for the blood to flow and the heart to pump.

There are two kinds of cholesterol, the good and the bad. LDL is the bad kind. It sticks to the artery walls and forms plaques that eventually narrow the passage. Saturated fats and trans fats raise LDL, and they are often found in packaged foods such as potato snacks and baked goods.

HDL, on the other hand, is the good kind and helps to lower LDL levels. It picks up LDL cholesterol from the artery walls and carries it to the liver, where it is removed from the body. Unlike LDL, HDL is not something you eat: your body makes it. Regular exercise, not smoking and healthy fats, such as those in nuts, fish and olive oil, help keep HDL levels up.

People who need to lower their LDL levels are also advised to eat plenty of fruit because of the fiber it provides. Oats, cereals and legumes are also great sources of soluble fiber, which can help combat the rise of LDL cholesterol and so reduce the risk of heart disease.

Factors that affect cholesterol levels

Contrary to popular opinion, it is not only food that matters when dealing with high cholesterol levels. There are actually a lot of factors that affect the condition. One of them is age and gender: levels tend to rise as we get older. Another is physical activity. Exercise can help lower LDL cholesterol and raise HDL, and it also strengthens the body and tones the muscles. Genetics, weight and smoking play a role too.

Lowering cholesterol levels

From what was said above, it seems wise to lower cholesterol levels, if one has the discipline to see it through. Just eat right and exercise regularly, limit packaged and fried foods, and you are on your way to lower cholesterol levels.

A cholesterol test report is full of numbers, and it is easy to feel lost. Knowing what each one means makes it much simpler to see where you stand and what, if anything, to change. Here is a plain guide to the main numbers, with the levels that MedlinePlus lists as healthy for most adults.

What does a cholesterol test measure?

A standard blood test, called a lipid panel, shows your total cholesterol, LDL cholesterol, HDL cholesterol and triglycerides. LDL is often called “bad” cholesterol because it is the main source of cholesterol buildup and blockage in the arteries. HDL is the “good” kind, because it helps remove cholesterol from your arteries. Triglycerides are not cholesterol, but they are another type of fat in the blood, and they can also raise your risk of heart disease. Some reports also give a non-HDL number, which is your total cholesterol minus your HDL.

Your doctor may ask you to fast for 9 to 12 hours before the test, which means nothing but water. Follow the instructions you are given.

What are healthy levels?

MedlinePlus gives these general targets for adults aged 20 and older, measured in milligrams per deciliter (mg/dL): total cholesterol under 200, non-HDL under 130, and LDL under 100. HDL of 60 or more is best, and below 40 in men or below 50 in women is considered low. Triglycerides are normal below 150, borderline high at 150 to 199 and high at 200 or more. Your own targets may differ with your age, blood pressure, weight, family history and other conditions, so ask your doctor what they should be for you.

Why does the balance matter?

Having a lot of LDL and little HDL is what puts you at risk. Over time, extra LDL helps form plaque on artery walls, which can narrow them, and this can lead to heart attack or stroke. A high number is not a diagnosis of anything by itself, but it is a warning that is worth acting on while you can still do so with food and exercise.

How can you improve your numbers?

There are four main routes, and they usually work best together.

Eat for your heart. Eat less saturated fat from fatty meat, butter and full-fat dairy, and more fish, fruit, nuts, oats and vegetables. See our guides on how to lower cholesterol through diet and a diet to lower cholesterol.

Move more. Regular physical activity lowers LDL and triglycerides and raises HDL. Our post on exercise and cholesterol explains how much to aim for.

Aim for a healthy weight. The National Heart, Lung, and Blood Institute notes that adults with overweight or obesity can lower LDL and raise HDL by losing only 3% to 5% of their weight.

Take medicine if your doctor recommends it. Several kinds exist, including statins, ezetimibe and bile acid sequestrants. Read more in our post on when lifestyle is enough and when medicine helps. Some of these drugs have side effects, so your doctor should explain them to you before prescribing.

How often should you get tested?

Practice varies with your age and risk, but according to MedlinePlus, younger adults aged 21 to 65 should generally have the test every 5 years, and men aged 45 to 65 and women aged 55 to 65 every 1 to 2 years. People older than 65 should be tested every year. If cholesterol problems, early heart disease or diabetes run in your family, your doctor may suggest testing sooner or more often. A regular checkup costs far less than treating a heart attack, and it gives you the chance to prevent one.

The Atkins diet is one of the best-known low-carbohydrate plans, and the old version of this post listed its benefits and its few downsides. It also said that low-carb eating has been “scientifically proven” to improve insulin sensitivity, blood pressure and blood insulin, and that dieters lose less muscle than on low-fat plans. I could not support those claims, so this rewrite goes back to the studies.

What are the possible benefits?

A 2013 meta-analysis in the British Journal of Nutrition looked at 13 trials with 1,415 people who followed a very-low-carbohydrate diet or a low-fat diet for at least a year. The low-carb group lost about 0.9 kg (2 pounds) more on average, had lower triglycerides, a slightly lower diastolic blood pressure and higher HDL (“good”) cholesterol, but also higher LDL (“bad”) cholesterol. The authors described the differences as statistically significant but small in practical terms. A larger 12-month trial of 609 adults found no significant difference between a healthy low-carb and a healthy low-fat diet (6.0 kg lost compared with 5.3 kg), which fits the common advice that the best plan is usually the one you can keep following. See the meta-analysis abstract for the details.

Is it really “eat what you like”?

The old post argued that steak, butter and cream are a regular part of the plan, and that former dieters would enjoy the “forbidden” foods. That freedom is part of the appeal, but it is also the part doctors worry about. Harvard Health notes that these diets often look like plates piled with bacon, meat, eggs and cheese, and that the American Heart Association recommends about 13 grams of saturated fat a day (6 percent of a 2,000-calorie diet). A 20-week trial that fed people high-saturated-fat low-carb diets did not show worse heart-risk markers, but it was short, and how such diets affect heart attacks or strokes in the long run is unknown. Vegetables, nuts, fish and olive oil make a safer base than processed meat.

What are the downsides?

The first two weeks are the hardest. Cleveland Clinic says that “keto flu” symptoms (headache, fatigue, irritability, nausea, constipation or diarrhea) can appear two to seven days after you reach ketosis and last between two days and a month, usually somewhere in between. The old post said these effects are “transient” but that some people quit because of them, which is fair. Harvard Health adds that a strict ketogenic diet can raise LDL cholesterol, and that using it for a long time is linked to a higher risk of kidney stones, osteoporosis and gout. Low-fiber eating can also cause constipation, so keep non-starchy vegetables on the plate.

What about carb counting and your personal carb level?

The old post said some people can maintain weight on 90 grams of carbohydrate a day and others on 120. Atkins now says that most people’s personal carb tolerance is 40 to 120 grams of net carbs a day, and that you find yours in the later phases. Atkins has also renamed its plans, so the names of the phases may differ from the old ones. Our post on Atkins Diet basics explains the structure, and Atkins induction rules walks through the first two weeks.

Who should talk to a doctor first?

If you are pregnant or breastfeeding, have kidney disease or a history of disordered eating, or take medicine for diabetes, speak with your doctor before you start. The American Diabetes Association’s standards say that low-carb plans are not recommended for pregnant or lactating women, people with or at risk of disordered eating, or people with kidney disease, and that they should be used with caution with some diabetes medicines called SGLT2 inhibitors. Our guide to common mistakes Atkins dieters make helps you avoid the usual traps. Finally, the old post said “it works” for thousands of dieters, which is true for short-term weight loss, but the research shows that the long-term difference is small.

The old version of this post said that high cholesterol is a growing problem, that heart disease is “highly preventable,” and that lowering cholesterol naturally is possible through diet, exercise and supplements. That is partly true, and this rewrite keeps the question and checks each part against reliable sources.

Why does cholesterol matter?

MedlinePlus explains that too much cholesterol in your blood can stick to the walls of your arteries and narrow or even block them, which raises your risk of coronary artery disease and other heart diseases. According to the CDC’s National Center for Health Statistics, heart disease was the leading cause of death in the United States in 2023, with 680,981 deaths, or 22.0 percent of all deaths. The old post said heart disease is “highly preventable.” A healthy lifestyle lowers your risk, but it cannot guarantee that you will avoid it, especially if your genes or other conditions are involved.

Which natural steps have good evidence?

The National Heart, Lung, and Blood Institute lists these lifestyle changes for lowering LDL (“bad”) cholesterol:

Eat heart-healthy foods, such as in the Therapeutic Lifestyle Changes (TLC) and DASH eating plans, which limit saturated fat and favor whole grains, fruits, vegetables and nuts. Get regular physical activity, which can lower LDL and triglycerides and raise HDL (“good”) cholesterol. Aim for a healthy weight, because losing only 3 to 5 percent of your body weight can lower LDL and raise HDL. Manage stress, quit smoking, sleep 7 to 9 hours a night and limit alcohol. This matches the old post’s advice on diet, exercise and quitting smoking, and adds weight, sleep and stress.

What about the foods the old post named?

The old post recommended soy products, vegetables, fruit and high-fiber foods. MedlinePlus agrees that soluble fiber helps prevent your digestive tract from absorbing cholesterol, and suggests 10 to 25 grams a day from foods such as oatmeal, oat bran, apples, oranges, pears, beans and lentils. It also recommends keeping saturated fat below 7 percent of your daily calories. For a food-by-food guide, see eating to lower cholesterol with oats, fruit, beans and healthy fats.

Do niacin and lecithin work?

The old post said B-complex vitamins, niacin in particular, and lecithin can lower cholesterol. This is the weakest part of the old text. Niacin in doses high enough to affect cholesterol is a drug-level dose and should be used only under a doctor’s supervision, and I could not find solid evidence that lecithin supplements lower cholesterol. Our post on cholesterol, vitamins and drugs looks at the evidence for both.

When is medicine needed?

The old post said drugs are mostly for high-risk patients. The NHLBI puts it differently: your provider may recommend lifestyle changes and medicines, and the plan depends on your cholesterol levels, your risk of heart disease, other medical conditions and your lifestyle. Statins are the most common medicine and, according to the NHLBI, lower the risk of heart attack and stroke in people with high LDL cholesterol. If you have a strong family history of high cholesterol, lifestyle changes may not be enough on their own. Never stop a prescribed medicine without talking to your provider.

What should you do next?

Ask for a cholesterol test and learn what the numbers mean in understanding your cholesterol numbers. Add exercise and cholesterol to your routine, and use the CDC’s data brief on U.S. deaths in 2023 as a reminder of why it matters.

Nobody can lower cholesterol overnight, and a number of things that raise it are out of your hands. Still, there is a lot you can do, and for some people a doctor will add medicine on top. This post explains what pushes LDL, the so-called “bad” cholesterol, up, what lifestyle changes realistically do, and what you should know about statins before you talk to your doctor.

What makes LDL cholesterol rise?

Some causes you cannot change. Your cholesterol tends to rise as you get older, and after menopause a woman’s risk goes up because her levels of protective female hormones fall. High cholesterol also runs in families, and an inherited condition called familial hypercholesterolemia causes very high levels from an early age. Diabetes, kidney disease and some medicines can raise LDL as well. The causes you can change are mainly what you eat, how much you move and your weight. A diet rich in saturated fat from fatty meat, full-fat dairy and fried or processed food raises LDL more than anything else in the diet, according to MedlinePlus.

Can you lower it instantly?

No. The idea that diet and exercise are “a waste of time” because they do not work at once is a myth. Eating less saturated fat, adding fiber from oats, beans and fruit, losing extra weight and moving more all lower LDL gradually over weeks and months, and they also help your blood pressure and blood sugar. Your doctor will usually repeat the blood test after a few months to see how far you have come. Start with our guides on what you can do to lower your cholesterol, how to lower cholesterol through diet and exercise and cholesterol.

When do doctors add medicine?

If changes to your lifestyle do not bring your LDL down enough, or if your risk of heart disease is high, your doctor may prescribe a statin. Statins lower LDL by slowing down how much cholesterol the liver makes, and they help the liver remove LDL already in the blood. Studies have shown that they lower the risk of heart attack and stroke in people with high LDL. Statins usually cause no side effects. They may raise the risk of type 2 diabetes, mostly in people who are already at high risk of it, and they can cause abnormal liver blood tests, although real liver damage is very rare. Muscle damage is also rare. You should not take statins if you are pregnant or breastfeeding. Grapefruit and grapefruit juice can interfere with some statins, so ask your doctor or pharmacist. See the MedlinePlus page on statins for more detail.

You may see exact percentages quoted for one brand-name statin in drug company announcements. Results differ with the drug, the dose and the person, so do not expect to match a figure from an advertisement. Other medicines exist too, such as ezetimibe, which blocks cholesterol absorption in the gut, and bile acid sequestrants. Which one suits you is a decision for you and your doctor.

What should you tell your doctor?

Before you start any cholesterol medicine, tell your doctor about any liver or kidney problems, and whether you are pregnant or planning to be. Mention how much alcohol you drink, whether high cholesterol or early heart disease runs in your family, and whether you have diabetes, a thyroid condition or a past heart attack or stroke. List every other prescription, over-the-counter medicine and supplement you take, including antacids. Mild side effects such as an upset stomach or muscle aches should be reported, and they often settle or improve if the drug or dose is changed.

Which cooking oil is best?

Some articles claim that coconut oil is the best oil for cholesterol. That is not what the evidence shows. A 2017 advisory from the American Heart Association found that coconut oil raises LDL cholesterol, as butter and palm oil do, and it advises against using it. The advisory recommends replacing saturated fats with unsaturated ones, and olive oil, which is low in saturated fat, is one good choice. Other plant oils such as canola, sunflower and soybean oil also work.

The bottom line: aim to change your habits first, have your cholesterol checked regularly, and treat medicine as an extra tool when your doctor thinks you need it, never as a replacement for healthy eating and exercise.

Book: Lower LDL Cholesterol Naturally with Food by Michael Greger and Kristine Dennis
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