Veggie Blog

Everybody knows that high cholesterol is something to be concerned about. But what does it really mean when your doctor tells you that your cholesterol levels are high, and what should you do about it? If you’re worried about your cholesterol, here’s your chance to get the answers you need from a top expert at the Harvard Medical School.

This book doesn’t just cover cholesterol, but heart health in general. It starts with what cholesterol is and how your body manufactures it and the mechanics of heart disease, then moves on to risk factors and what will happen when you visit your doctor about this. Then it goes to how to lower your cholesterol and, thus, your heart disease risk. Diet, exercise, medications. He includes special cases- children with high cholesterol, seniors, people with established heart disease and diabetics. He gives a chapter to alternative and complementary approaches- and doesn’t think much of any of them.

It’s a very thorough book- the explanation of heart disease is very good. High cholesterol is not a problem on its own- it’s the things it does to the arteries, and it works by several different mechanisms. Of course, even though the book is only five years old, the results of some of the studies he cites have been overturned by newer ones, but for the most part, it’s a good, solid book.

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A good diet can lower cholesterol

Take James, a father of two, who went for a routine medical check-up. He exercised moderately and loved to eat, but everything was about to change when his results came back.

What did the results show?

His LDL cholesterol, the type often called “bad” cholesterol, was well above the recommended level. The doctor said that if nothing changed, James could soon suffer from high blood pressure, a heart attack or a stroke. As a father of two, he took the warning very seriously, because he wanted to keep providing for his family.

What did the doctor change?

James had been exercising twice a week, and the doctor advised him to do more. He started exercising four times a week and added other activities to help lower his cholesterol. Health authorities recommend at least 150 minutes of moderate activity a week for adults.

The doctor also pointed out that there is no use in exercising more if what you eat does not change, because the food you burn off is just replaced by the next meal. James was referred to a dietitian, who went through his usual foods with him. The ones that were high in saturated fat were set aside and replaced with healthier choices.

What did a day of eating look like?

The plan looked simple. James would eat food that was low in saturated fat and no longer rich in refined carbohydrates.

Breakfast: Because his LDL was high, the dietitian suggested egg whites instead of whole eggs, unsweetened tea in place of his morning coffee, and cereal with fat-free milk when he ate with the kids.

Lunch: Skinless chicken or a small portion of lean meat with plenty of vegetables and side dishes. Vegetarians can swap in beans, lentils or tofu.

Snack: It takes time to adjust, and anyone new to this will feel hungry in the late afternoon. Carrot sticks or an apple are a much better choice than a donut that is full of sugar. Instead of cola, he drank water or an unsweetened drink.

Dinner: Fish, or pasta with vegetables on the side. There was no need to fill up, since he would be sleeping for the next six to eight hours.

Alcohol: James gave up beer. A small glass of wine with dinner may be acceptable for people who already drink and whose doctor agrees, but if you do not drink, do not start.

James also learned to make good choices when eating out or at gatherings. For someone at risk of heart disease or high blood pressure, there is no room for slipping, and the whole family benefited from the change.

What was the result?

At the follow-up check-up, James’s cholesterol had improved, with his LDL much lower than before. The plan he chose is only one of many. It can take some time to find the right one, but lowering your cholesterol is well worth the effort.

What can you learn from his story?

The American Heart Association recommends that people with high LDL cholesterol limit saturated fat to less than 6% of their calories, which means about 13 grams a day on a 2,000-calorie diet. Swap butter, full-fat cheese and fatty meat for olive oil, nuts, beans and oats, and have your cholesterol checked again to see the effect. Read more in our posts on how to lower cholesterol through diet, a diet to lower cholesterol, eating to lower cholesterol with oats, fruit, beans and healthy fats, and exercise and cholesterol.

Debates about cholesterol can be confusing because two statements can both be true: cholesterol is essential to human life, and high levels of LDL cholesterol in the bloodstream contribute to atherosclerotic cardiovascular disease. The book discussed in the original version of this post challenges widespread statin use. Here is how to read that argument in the context of current evidence.

What is this book about?

The original description refers to a former astronaut and physician who investigated an episode of transient global amnesia that he associated with statin treatment. The site’s historical tags identify Dr Duane Graveline and Statin Drugs: Side Effects and the Misguided War on Cholesterol. The description argues that cholesterol matters for brain function and that statins can affect several body systems. Those are claims presented by the book, not findings established by the description itself.

Why does the body need cholesterol?

Cholesterol is a component of cell membranes and a starting material for steroid hormones and bile acids. Much of the body’s cholesterol is produced internally. The health concern is not the existence of cholesterol but the risk associated with excess circulating LDL cholesterol, particularly over many years and in people with additional risk factors.

What do statins actually do?

Statins reduce the liver’s cholesterol production and increase clearance of LDL from the blood. In appropriately selected patients, large clinical trials have found reductions in major cardiovascular events such as heart attacks and ischaemic strokes. The size of an individual’s benefit depends on their baseline risk and the extent of LDL lowering.

Do statins cause memory loss or dementia?

Some people have reported memory problems during statin use, and reported symptoms deserve clinical attention. However, a 2023 American Heart Association scientific statement concluded that most observational evidence and randomised trials do not support the proposition that LDL lowering or statin treatment causes dementia. It also highlighted areas where evidence remains incomplete, especially in selected populations.

What about side effects?

Muscle symptoms, drug interactions and changes in glucose metabolism are relevant considerations. A patient who develops symptoms should speak with their prescriber about alternative causes, dose adjustments or a different treatment—not simply stop therapy without discussing cardiovascular risk.

How should readers approach a critical book?

Read the author’s personal story as a reason to ask questions, not as proof that one experience predicts everyone’s outcome. A useful discussion with a healthcare professional covers your absolute cardiovascular risk, LDL level, expected treatment benefit, potential adverse effects and preferences.

Evidence and background: American Heart Association scientific statement; MedlinePlus: Statins.

Related on Veggie-Blog: Understanding Your Cholesterol Numbers.

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Lowering LDL cholesterol usually starts with small habits that you can sustain. Food choices, movement and other lifestyle changes can improve your cardiovascular risk profile, although some people also need medication. This guide gives you ten practical starting points, then looks at the book Cholesterol Down, which inspired the original version of this page.

Ten simple steps to support healthier cholesterol

1. Know your numbers. Ask for a lipid panel and discuss LDL cholesterol, non-HDL cholesterol and other risk factors with your clinician. Your target depends on your overall cardiovascular risk.
2. Choose oats or barley regularly. These grains provide soluble fibre, which can help lower LDL cholesterol as part of an overall healthy diet.
3. Eat beans, lentils and other pulses. They supply fibre and plant protein and can replace meals centred on processed or fatty meats.
4. Include nuts in sensible portions. Unsalted walnuts, almonds and other nuts can be part of a heart-healthy eating pattern.
5. Replace saturated fats with unsaturated fats. For example, choose olive or rapeseed oil rather than butter more often, while keeping overall portions appropriate.
6. Fill more of your plate with vegetables and fruit. Variety makes a fibre-rich eating pattern easier to maintain.
7. Choose whole grains. Swap some refined grains for wholegrain bread, brown rice or other minimally processed alternatives.
8. Move regularly. Walking, cycling or swimming supports cardiovascular health; build up gradually to a level suitable for you.
9. Avoid tobacco and address other risks. Smoking, blood pressure and diabetes matter alongside cholesterol when assessing heart and stroke risk.
10. Follow up rather than guessing. Repeat testing when your clinician recommends it and review whether lifestyle changes are sufficient or medication is indicated.

Where does the book Cholesterol Down fit in?

The original post introduced Dr Janet Brill’s Cholesterol Down, a book describing a ten-point dietary plan. Its description mentions daily checklists, a six-month LDL-tracking chart, risk-assessment tools, sample menus and recipes. These may help readers organise their efforts, but the book’s promotional language about “miracle foods” should not be mistaken for a medical guarantee.

Can food replace statins?

Not for everyone. Lifestyle changes are valuable whether or not someone uses medication, but people with established cardiovascular disease, markedly elevated LDL cholesterol or other major risk factors may need LDL-lowering treatment. MedlinePlus explains that statins reduce LDL cholesterol and lower heart attack and stroke risk in appropriate patients. Never discontinue a prescribed medicine simply because a diet book suggests an alternative.

What is the best first step?

Choose two changes that fit your routine—perhaps an oat-based breakfast and a daily walk—and book a conversation about your lipid results. A workable plan beats a perfect one that lasts only a week.

Further reading: MedlinePlus: Cholesterol; MedlinePlus: Statins.

Related on Veggie-Blog: Exercise and Cholesterol.

Explore Cholesterol Down on Amazon (affiliate link; we may earn a commission at no extra cost to you).