Elevated cholesterol levels are associated with a greater risk of heart disease and stroke. But it is possible to manage your cholesterol. Some people may be able to lower cholesterol naturally without medication; others may require statins to help bring cholesterol levels back into the optimal range.
Here’s what you need to know about cholesterol-lowering medications like statins as well as lifestyle habits that can help naturally lower cholesterol.
Cholesterol is a waxy, fat-like substance found in cells. It plays a vital role in digestive processes and helps produce hormones and vitamin D. The body makes all of the cholesterol you need. [1] While the body requires some cholesterol for normal processes, too much is unhealthy.
When people talk about high cholesterol, they’re usually referring to low-density lipoprotein (LDL) “bad” cholesterol, as this type increases your risk of heart attack, stroke, and other health issues. Below 100 mg/dL is considered optimal for LDL cholesterol. [2] High-density lipoprotein (HDL) “good” cholesterol is protective: it helps remove cholesterol from circulation to prevent damage to blood vessels. [3]
For most people, dietary cholesterol has minimal impact on blood cholesterol. Rather, serum cholesterol levels are influenced by saturated fat and the type and amount of carbohydrates you eat.
Statins are medications that manage and treat high cholesterol by lowering LDL, triglyceride, and total cholesterol levels and raising the concentration of HDL cholesterol. Statins inhibit the enzyme hydroxymethylglutaryl-CoA reductase (HMG-CoA), which decreases liver production of cholesterol, especially apoB-containing lipoproteins (ApoB) and encourages more LDL cholesterol to be removed from circulation and brought into the liver for excretion. [4]
As a prescription medication, statins are managed by a healthcare provider. And the decision to initiate statins should be made in consultation with a physician. When to start statins depends on many factors, such as the number of cardiovascular risk factors (diabetes, hypertension, dyslipidemia, or smoking) and the estimated 10-year risk of a cardiac event. [5,6]
For some people, it may be possible to reduce the dosage or discontinue statins through lifestyle modifications, such as diet and exercise. But statins are helpful and necessary for many people. For those at high risk or with a history of heart attacks or stroke, the American Heart Association discourages discontinuing statins, as these medications can reduce the risk of cardiac events by up to 50 percent. [7] Always consult your healthcare provider before making any changes to medications.
While statins are vital to ensure optimal heart health in people at high risk of cardiac events, lifestyle interventions may sufficiently lower cholesterol in some individuals with borderline high levels. And routine blood work allows you to monitor your cholesterol so you can enact changes before problems arise and track your progress toward heart health.
Certain dietary recommendations and participating in physical activity can help you naturally lower cholesterol levels or help maintain optimal cholesterol levels.
Research shows that trans fats—found mainly in processed foods—raise LDL and total cholesterol levels while lowering HDL cholesterol. Guidelines recommend avoiding trans fats due to their association with an increased risk of developing cardiovascular disease. [8]
A high saturated fat intake increases ApoB, LDL cholesterol, and total cholesterol concentrations. [9] And the Dietary Guidelines for Americans 2020-2025 recommends people reduce saturated fat— which is predominantly found in animal products and processed foods—to less than 10% of daily calories. [10]
Monounsaturated fatty acids (MUFA) and polyunsaturated fatty acids (PUFA) are considered “healthy” fats because of their beneficial effects on cholesterol levels.
MUFAs are found in common food sources, such as olive oil, nuts, and avocados.
PUFAs encompass both omega-3 and omega-6 fatty acids. Sources of omega-3 include fatty fish (trout, herring, and salmon), walnuts, and flaxseed, while omega-6s abound in vegetable oils, such as soybean, corn, and safflower.
Swapping saturated fat for monounsaturated fat lowers LDL cholesterol. One study found MUFAs lowered LDL cholesterol in a dose-dependent manner: consuming 51% compared to 25% of fat intake in the form of monounsaturated fats more significantly reduced LDL cholesterol concentrations. [11] Another study found replacing saturated fat with MUFAs decreased total cholesterol by 12% and LDL cholesterol by 15%. [12]
Replacing saturated fat with polyunsaturated fat has an even more pronounced effect on cholesterol levels. In one study, swapping saturated fat for omega-6 PUFAs reduced total cholesterol by 19% and LDL cholesterol by 22%. [12] What’s more, choosing PUFAs instead of MUFAs can more significantly lower LDL cholesterol when replacing saturated fat. [13]
Despite the beneficial effects of unsaturated fats on cholesterol, it is still important to be mindful of portion size, as excessive intakes of calories—no matter the source—can contribute to changes in body composition and insulin resistance.
Soluble fiber is a non-digestible carbohydrate found in foods such as lentils, beans, oats, nuts, flaxseeds, and some fruits. You can lower your cholesterol naturally by increasing soluble fiber consumption. Soluble fiber binds to bile (a digestive juice made of cholesterol) and directs its removal from the body. So the liver takes more cholesterol out of circulation to form bile. This process results in reduced circulating levels of cholesterol. [14]
Pulses (beans, lentils, and peas) are a rich source of soluble fiber. Eating 1.5 cups of pulses per day lowered total cholesterol by 8.3% and LDL cholesterol levels by 7.9% compared to a regular diet. [15] And opting for pulses as a source of protein instead of animal meat not only lowers saturated fat intake but also increases soluble fiber—a double whammy for lowering cholesterol naturally.
Some forms of soluble fiber, like psyllium husk and beta-glucan, are even more effective at lowering cholesterol levels. These forms create a gel-like, viscous solution in the body that more aggressively traps cholesterol for removal.
Psyllium husk lowers apoB, LDL, and total cholesterol levels. Aim for two, five-gram servings of psyllium husk daily to help reduce cholesterol levels. [14,16,17]
In one randomized control trial of healthy people, consuming three grams per day of beta-glucans (abundant in oats) resulted in a 15.1% decrease in LDL cholesterol levels and an 8.9% reduction in total cholesterol concentration after 8 weeks of supplementation. [18] Another study found consuming 50-100 grams of oats (the equivalent of ½-1 cup of oatmeal) daily lowered total and LDL cholesterol in people with type 2 diabetes. [19]
Sometimes supplements may provide a boost to help you naturally lower cholesterol levels. Any time you add a supplement to your regimen and especially if you’re already on medication, it’s important to talk with a healthcare provider to ensure there are no potential interactions.
But before starting a new supplement, it’s always best to consult your healthcare provider to see whether it will be safe and effective for you.
References:
[1] https://medlineplus.gov/cholesterol.html
[2] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625
[3] https://www.nhlbi.nih.gov/health/blood-cholesterol
[4] https://www.ncbi.nlm.nih.gov/books/NBK430940/
[6] https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625#d1e757
[7] https://www.ahajournals.org/doi/10.1161/jaha.115.002497
[8] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7231579/
[9] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5293238/
[11] https://academic.oup.com/ajcn/article/78/1/47/4689896?login=false
[12] https://pubmed.ncbi.nlm.nih.gov/11593354/
[13] https://pubmed.ncbi.nlm.nih.gov/1386252/
[14] https://academic.oup.com/ajcn/article/108/5/922/5098499?login=false
[15] https://pubmed.ncbi.nlm.nih.gov/22916805/
[16 https://pubmed.ncbi.nlm.nih.gov/20413122/
[17] https://pubmed.ncbi.nlm.nih.gov/10837282/
[18] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7146517/
[19] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5037534/
[20] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6521758/
[21] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6547799/
[22] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4581708/
[23] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9238648/
[24] https://pubmed.ncbi.nlm.nih.gov/15640382/
[25] https://pubmed.ncbi.nlm.nih.gov/23329606/
[26] https://pubmed.ncbi.nlm.nih.gov/29990473/
[27] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4252524/
[28] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1821028/
[29] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8954273/