Cholesterol is a waxy, fat-like substance that circulates in your blood. It’s made by the liver but also enters the body via some of the foods we eat, particularly those high in saturated fats like red meats, butter, and processed foods. Cholesterol gets a bad rap because of its link to heart disease, but in actuality, it’s necessary for good health. It helps build cell membranes and make hormones and vitamins. But too much of anything can be bad, including cholesterol.
Cholesterol becomes a problem when excess amounts build up on artery walls, causing blockages that can lead to heart attacks and strokes. High cholesterol is a common yet silent condition. According to the Centers for Disease Control and Prevention (CDC), 93 million Americans over the age of 20 have high cholesterol, and many don’t know it.
Cholesterol is carried through your bloodstream via lipoproteins, particles that have cholesterol on the inside and protein on the outside. There are three types of cholesterol:
- Low-density lipoprotein (LDL) carries the cholesterol that moves out of the liver and into the bloodstream. It’s known as the “bad” cholesterol because it can clog and narrow blood vessels, leading to cardiovascular disease.
- High-density lipoprotein (or HDL) carries the “good” cholesterol. It moves from the blood back to the liver, where it’s broken down.
- Very low-density lipoprotein (VLDL) carries triglycerides, a fat (and not cholesterol) that can raise your risk for heart disease if levels are too high.
What’s considered high cholesterol?
The American Heart Association (AHA) recommends that all adults 20 and older have their cholesterol levels checked every four to six years. This is done via a blood test called a lipid panel. If you have certain risk factors for high cholesterol—for example, it runs in your family, you smoke, are overweight, or have conditions like diabetes or an autoimmune disease—you may need more frequent screening.
|Optimal||Less than 200 mg/dL|
|Borderline HIgh||200-239 mg/dL|
|High||240 mg/dL and greater|
|Optimal||Less than 100 mg/dL|
|Near Optimal||100–129 mg/dL|
|Borderline High||130–159 mg/dL|
|High||160 mgdL and greater|
|Optimal||60 mg/dL and greater|
|Too low||Less than 40 mg/dL|
Another metric to be aware of is your triglyceride level. Most of the fat in your body is made up of triglycerides. Overall, a healthy range for triglycerides is less than 150. A measurement of 150-199 is considered borderline high; 200 and greater is high.
Is it ever possible for your HDL, the “healthy” cholesterol, to be too high and your LDL, the “lousy” cholesterol, be too low? Experts at the Cleveland Clinic say yes, but it’s rare. Very high and very low cholesterol levels can point to certain health problems and should be investigated. Low LDL levels, for example, have been associated with depression and certain kinds of stroke. High HDL levels have been linked to cancer.
12 ways to lower cholesterol
Your cholesterol levels aren’t static. They fluctuate based on your diet, your activity levels, your age, and a variety of other factors. While you can’t control every factor, there is a lot you can do to help lower your cholesterol levels.
1. Increase soluble fiber
Soluble fiber is a type of fiber that forms a gel when digested. This gel helps to absorb things like cholesterol and fat in the intestines before they can move to the bloodstream. Foods rich in soluble fiber include oats, barley, fruits such as apples, oranges and berries, and vegetables like brussel sprouts. A recent study looking at adults with mildly high cholesterol levels found that those who ate two apples a day over an eight-week period were able to lower their cholesterol levels. The Cleveland Clinic notes that eating one and one half cups of oatmeal a day can lower cholesterol by 5% to 8%. And added bonus: Many foods high in soluble fiber also contain polyphenols, plant-derived antioxidants that can also help lower cholesterol.
2. Reduce saturated fat
Saturated fat—found in things such as red meats, bacon, butter, high-fat dairy products, and processed foods like packaged cakes and cookies—can increase cholesterol levels by making the liver less efficient at breaking down cholesterol pulled from the blood. The AHA recommends that saturated fat should only make up 6% of your daily calories. Experts recommend replacing saturated fats with more heart-healthy monounsaturated or polyunsaturated fats, which include olive oil, avocados, and most nuts.
3. Add omega-3 fatty acids
Some of the best sources of omega-3 fatty acids—which are thought to lower the production of cholesterol and triglycerides in the liver—are oily fish (for example, salmon, mackerel, and sardines) as well as nuts and ground flax seeds. A review of 15 studies found that eating 4g of omega-3 fatty acids daily lowered triglycerides by 25% to 30%, increased LDL by 5% to 10%, and raised the good HDL cholesterol by 1% to 3%. What probably won’t work? Taking fish oil supplements. “Fish oil in high doses may help lower triglycerides, but it doesn’t lower LDL cholesterol,” says Patrick Green, MD, a cardiologist at UCHealth in Fort Collins, Colo.
4. Avoid or limit cholesterol-raising foods
- Fatty meats, like well-marbled steaks, bacon, and sausages, among others
- Store-bought cakes and cookies, which are often made with saturated fat
- Processed foods like crackers, hot dogs, deli meats
- High-sugar foods and refined carbohydrates (candies, sodas, white pasta, white rice, etc.), which raise your body’s LDL and decrease HDL. When it comes to sugar added into food, the AHA recommends that women consume no more than 24 grams daily and men 36 grams.
One important thing to note: Don’t necessarily shy away from egg yolks or shellfish. While they are high in cholesterol, they don’t seem to have an effect on cholesterol in the bloodstream and they contain many important nutrients.
Healthy lifestyle changes are key to lowering cholesterol. But it’s important to note that the amount of reduction will vary from person to person and by how significant the changes are, notes Dr. Green.
Regular exercise improves liver function and the way your liver uses fats. In one analysis of 51 exercise interventions lasting 12 weeks or more, it was found that aerobic exercise (think jogging, running, or cycling) raised HDL cholesterol by 4.6% on average while lowering triglyceride levels 3.7% and LDL cholesterol levels by 5%. The same analysis found low-to-moderate resistance training to also be effective in lowering cholesterol. “If you can reduce the amount of fat in your liver through things like diet and exercise, then you can improve the way the liver handles lipid production,” comments Ian Neeland, MD, director of cardiovascular prevention at University Hospitals Harrington Heart & Vascular Institute in Cleveland, Ohio.
6. Weight loss
Because of the way it impacts your liver and its cholesterol production, extra weight can raise your triglycerides and lower your HDL levels. That’s not to say that people who are in the normal weight range or are even underweight don’t have cholesterol problems. But in general, cholesterol tends to creep up as the excess pounds do. In fact, research shows that 60% to 70% of people with obesity have unhealthy cholesterol profiles. The good news? Even moderate weight loss—as little as 5% to 10% of your body weight, some studies suggest—can have cholesterol-lowering effects.
7. Quit smoking
Researchers aren’t exactly sure why, but in one study published in the American Heart Journal, people who quit smoking for a year had about a 5% increase in their HDL levels—this, despite the fact that many of them gained an additional 10 pounds over that year.
A supplement may help to lower your cholesterol—but the operative word is may. Many don’t have enough well-executed, scientific studies behind them to support their claims. And supplements in this country don’t undergo the rigorous safety and efficacy tests drugs must pass before they come to market. Purity standards and ingredient concentrations are also not regulated. Bottom line: Buyer beware. And talk to your healthcare provider before taking any supplement.
8. Red yeast rice
Red yeast rice is a rice product that’s fermented with a type of yeast. “It contains a substance called monacolin K, chemically identical to the active ingredient in lovastatin [a drug that slows the production of cholesterol in the body]. It can lower cholesterol 10% to 20% depending on quality from the manufacturer,” says Dr. Green.
Lifestyle and dietary changes won’t always bring cholesterol down to healthy levels. Your doctor may prescribe medication if that is the case. The AHA recommends cholesterol-lowering drugs for people who:
- Are age 40-75 and have diabetes
- Have LDL cholesterol of 190 mg/dL or higher
- Are age 40-75, have an LDL reading of 70-189 mg/dL, and have a 5%–20% or greater risk of heart disease due to hardening of the arteries within 10 years (doctors calculate risk using a formula that includes factors such as your age, gender, smoking history, etc.)
10. Cholesterol absorption inhibitors
Medications like Zetia (ezetimibe) prevent the intestines from absorbing cholesterol.
11. Bile acid-binding agents
12. PCSK9 inhibitors
PCSKP is a protein made in the liver. People with a lot of this protein tend to have high cholesterol. “PCSK9 inhibitors are a relatively new class of cholesterol-lowering meds,” explains Dr. Green. “They have the effect of increasing LDL receptors in the liver, which in turn remove LDL cholesterol from the blood. These medications are self-injected, typically every two weeks.” Some medication names include Praluent (alirocumab) and Repatha (evolocumab).
How long does it take to lower cholesterol?
The good news is that with the right therapies—be they dietary and lifestyle changes and/or the use of medications—cholesterol can be lowered pretty quickly. “We usually wait three months to see maximum effects,” says Dr. Neeland. “But whether it’s with diet or medication, you can usually experience changes in just a week or two.”