Have you been told you that your cholesterol level is too high?
Has your doctor even recommended a prescription medication to lower it?
Is a high cholesterol level dangerous? Is there anything that you can do to help?
In this article, I will discuss how you can lower your cholesterol level naturally WITHOUT medication.
The discussion will include which foods you should avoid, which foods you should eat, supplements that help, and other lifestyle changes that can help get your cholesterol level back into the optimal range.
Ready, set, go...
Cholesterol is a lipid molecule that is produced by all animal cells. It is an essential structural component of all animal cell membranes. In fact, about 30% of cell membranes are cholesterol. The vast majority of cholesterol is made by the liver.
Within the cell membrane, cholesterol plays a role in intracellular transport, cell signaling and nerve conduction.
Cholesterol is also a precursor to the production of hormones, bile acids, and vitamin D.
Cholesterol is transported inside lipoprotein particles throughout the body. These lipoproteins come in 2 primary forms - LDL and HDL (there are also VLDL and IDL particles, which I will not discuss in this article).
It is believed that low density lipoproteins (LDL) particles (as well as IDL and VLDL) promote the development of atheromas in artery walls while high density lipoproteins (HDL) particles promote the removal of those atheromas from the artery walls.
That is why most people call LDL the "bad" cholesterol while HDL is the "good" cholesterol. More recent research has shown a much more complicated picture than that, but that is general description of each lipoprotein.
The belief is if you can reduce the amount of LDL in the body, it will reduce the incidence of atherosclerosis (the laying down of plaque in the arteries). Therefore, less plaque = less heart disease.
But is it really that simple?
Keep in mind that cholesterol is essential for the body. We must have cholesterol to have normal cell membranes.
We also must have cholesterol to make many of the hormones in the body, including estrogen, testosterone, adrenal hormones and vitamin D.
Cholesterol is vital for forming memories and other critical neurological functions.
It also is the foundation for bile acids, which are required for fat digestion and the absorption of nutrients from our food.
So, cholesterol isn't bad. But high cholesterol is bad, right? Not necessarily.
What may be bad is when you have too much of the wrong forms of lipoproteins. The small, dense LDL particles are believed to be the ones that increase the risk for plaque formation.
However, this increased risk may be more theoretical than actual.
Multiple studies have attempted to show that a high cholesterol level (especially LDL) increases your risk for heart disease.
This meta-analysis from JAMA in 2016 involving 316,000 patients did show that lower levels of LDL were associated with lower rates of coronary events.
However, a systematic review and meta-analysis from the American Journal of Clinical Nutrition in 2015 looked at 40 studies involving over 361,000 patients. They were unable to draw any connection between cholesterol levels and an increase in heart disease risk.
Another systematic review from Cardiovascular Medicine Research in 2015 looked at 19 cohort studies of cholesterol levels and mortality in the elderly. To their surprise, not only was a high LDL level NOT associated with an increased risk of death, the exact opposite was found. People with the highest LDL levels lived longer!
So should we worry about cholesterol levels? My honest answer is I'm not sure.
People who live healthy lifestyles and eat natural, healthy foods have lower cholesterol levels than people who eat the standard American diet and have unhealthy lifestyles. The exception to this is people that have familial hyperlipidemia.
Cholesterol levels can then be used as an indicator of the diet and lifestyle that a person is living. You yourself probably know that when you are not eating well, your cholesterol levels increase, especially the LDL. When you aren't exercising, your HDL level drops.
Elevated levels of small, dense LDL does appear to slightly increase cardiovascular risk. Plus, I believe it is good to monitor our HDL and LDL levels as a way of measuring how healthy we are living.
So if your cholesterol levels are higher than you or your doctor would prefer, what can you do about it?
Chances are, your doctor will recommend that you start a statin drug. There is no doubt that these drugs will drop your cholesterol levels.
However, there are many side effects and even dangers that come with this class of medication (read my article here). There are also questions about how much they really prevent bad outcomes.
Of note, there are many experts that believe statins can reduce the risk of MI because of their anti-inflammatory and anticoagulant actions, NOT because they lower cholesterol.
In my opinion, if you have familial hyperlipidemia and/or if you are a man with established heart disease, you should probably be taking a statin drug (if you can tolerate it).
Everyone else (women, people with high cholesterol but no history of heart disease) should discuss it with their doctor first and really focus on diet and lifestyle as the primary means of reducing it.
Now let's talk about some things that you can do to naturally lower your cholesterol levels...
There are several things that you can do to lower your cholesterol, but like most health issues, you should always start with your diet.
Let's list some things that should definitely be avoided if your cholesterol is too high:
One of the most powerful things that you can do to lower your LDL cholesterol level is to remove the majority of sugar from your diet. The average American eats over 150 pounds of sugar every year.
We have all been told for years that too much fat in the diet raises cholesterol levels and sugar is harmless except for being empty calories. That just isn't true!
Sugar calories are deadly calories. Sugar causes heart attacks, obesity, type 2 diabetes, cancer and dementia, and is the leading cause of liver failure in America.
The biggest culprit for most people is sugar-sweetened drinks. The average American gets over 1/3 of their daily sugar calories from soft drinks! When you add sweetened tea, coffee, and energy drinks, that number is even higher.
Excess sugar intake leads to insulin resistance, elevated triglyceride levels, low HDL levels, increased levels of low density LDL particles, and an increase in inflammation. All of these cause an increased risk of heart disease, independent of any other risk factors.
A JAMA Internal Medicine study from 2014 showed that people eating the highest amount of sugar had a 400% higher risk of heart attack than people eating the lowest amount of sugar! The study showed that your risk of heart attack doubles if you get 20% of your calories from sugar.
That is a scary statistic, especially when you realize that over 10% of Americans get more than 25% of their calories from sugar!
Several countries worldwide have battled this epidemic by taxing soft drinks, banning junk food television advertising, and eliminating processed foods, junk food and sugar-sweetened beverages from schools. This study even calculated the potential health benefits of taxing soft drinks in the US.
I am personally not a fan of using government intervention as a way of controlling behavior in society, but it underscores the importance of increasing education in the areas of nutrition and health and putting pressure on companies to produce healthier food options.
Refined carbohydrates, also known as simple carbs or processed carbs, are just as dangerous as sugar. The average American eats almost 150 pounds of processed flour each year.
Refined carbs are carbohydrates that have been processed in a way that removes the majority of nutrients and fiber from them. When they are consumed, they are almost instantly converted into sugar in the body.
Examples of refined carbs includes bread, rolls, pizza, pasta, white rice, and most ready-to-eat cold cereals.
In a way, refined carbs are even more dangerous than table sugar. In fact, blood sugar levels rise higher when you eat processed flour than if you ate table sugar!
If you are over the age of 30, most of you will remember the low-fat craze of the 1980s and 1990s. At that time, it was felt that saturated fats were the absolute worst thing that you could eat.
Massive advertising campaigns were launched encouraging people to eat less fat. The unintended result was people replaced those fats in their diets primarily with refined carbs. Obesity, type 2 diabetes, and heart disease levels increased dramatically.
Finally, the medical community has realized their error and are SLOWLY changing their attitudes about refined carbs. This study showed that while eating a diet high in saturated fat is not good for you, it is still significantly better than eating a diet high in refined carbs.
Friends and family members that love a good wine often spout to me the benefits of alcohol consumption and how it reduces heart disease.
So what does the research say?
I think the research is clear that occasional alcohol is okay and may even have some mild benefits.
The key is that you should choose low carb options and drink no more than 1-2 drinks.
Alcohol tends to increase your cravings and appetite for bad foods.
If alcohol is something that you really want to have as a part of your life, at least keep these things in mind:
Beer is made from grains (oats, barley, wheat and rye), malt (sugar) and yeast. It was originally brewed to provide nourishment for adults (and children!), especially during times when food was scarce. Realize that when you drink beer, you are basically drinking a liquid meal.
Cider is fermented apple juice. Every 12 ounces of cider can have up to 30g of sugar!
Sweet liqueurs are similar to cider. They typically are loaded with sugar.
Rum is a low carb drink. However, most people mix it with high carb drinks such as sodas or energy drinks.
Red wine is generally low carb. It also contains resveratrol which is a potent anti-oxidant. Light to moderate consumption has been associated with a decrease in LDL, reduced atherosclerosis, and reduced oxidative stress. The danger is it tends to be often consumed with high carb foods such as pasta, pizza, etc., and it can increase your appetite for those types of food.
White wine as a general rule often contains more sugar and carbs than red wine. 5 ounces of wine equates to about 125 calories. Again, it may increase your cravings for foods that should be avoided.
Keep in mind that even if you drink in moderation, it will typically STOP weight loss and may even cause weight gain in my professional experience.
Trans fats, also called trans fatty acids, are a type of unsaturated fat that occur in small amounts in nature, but have become widely consumed due to industrialized food production.
Trans fat is formed through an industrial process that adds hydrogen to vegetable oil, which causes the oil to become solid at room temperature.
This partially hydrogenated oil is less likely to spoil, so foods made with it have a longer shelf life. Many restaurants also cook with it in their deep fryers because it needs to be changed less often.
Trans fats are commonly found in food such as margarine, ghee, snack food (such as chips) packaged baked goods, and fried fast foods.
Trans fats have been shown to lower HDL and raise LDL levels and may lead to an increase in heart disease.
This is just another example about why it is dangerous to eat out in restaurants excessively. You really don't know what you are eating or how they prepared your food!
People have tried to vilify caffeine for years, blaming it for anything from high blood pressure to stroke, cardiac arrhythmias, and heart disease.
But is caffeine really that bad?
The answer is probably not if consumed in moderation.
This literature review from 2017 showed that moderate caffeine intake is not associated with increased risks of total cardiovascular disease; arrhythmia; heart failure; blood pressure changes among regular coffee drinkers; or hypertension in baseline populations.
There is no evidence that I could find that suggests that caffeine intake increases cholesterol levels. Now, if you are adding a bunch of sugar to your coffee or tea, that is a different story.
My only caution would be in people who are suffering from adrenal fatigue. Caffeine puts added stress on the adrenals to produce cortisol levels which can be harmful when they are already strained from physical, mental, or emotional stress. In those situations I typically recommend stopping all caffeine until the adrenals have had time to recover.
By the way, there is also a suggestion that excessive caffeine intake make cause a decrease in bone density. According to this article, as long as you optimize your vitamin D level, eat foods with adequate calcium content, and don't drink more than 3 cups of coffee per day, the risk should be minimal.
So we've talked about the bad, now let's talk about the good. All of the foods in this segment have shown cardiovascular benefit in studies.
Omega-3 fats belong to the long chain poly-unsaturated fatty acids. The ones that have been shown to be beneficial for the heart and cholesterol are Eicosapentaenoic acid (EPA) and Docosahexaenoic acid (DHA).
These fatty acids come from marine microorganisms that are eaten by fish.
The fish with the highest omega-3 concentrations include fatty fish like tuna, salmon, sardines, mackerel, albacore and herring.
Omega-3 fatty acids primarily reduce triglyceride levels and lower VLDL levels. They also appear to have anti-inflammatory and anti-thrombotic effects.
If you aren't a fish fan, if you are a vegetarian, or if you have a sensitivity to fish, supplements are also available which I will discuss later.
Foods high in soluble fiber have been shown in studies to lower LDL cholesterol.
Soluble fiber attracts water and turns to a gel-like substance during digestion. This slows digestion and makes you feel full for a longer period of time. It also binds to cholesterol and may reduce its absorption in the intestines.
Examples of foods high in soluble fiber include oats, kidney beans, brussel sprouts, apples and pears.
Soluble fiber is also available as a supplement. These include psyllium, pectin, and guar gum.
Olive oil is full of healthy, monounsaturated fats, primarily oleic acid.
Oleic acid is believed to be a potent anti-oxidant that reduces inflammation.
Regular consumption of olive has been shown to reduce the risk for cardiovascular events and stroke. It also appears to reduce the risk of oxidation of LDL particles.
There are studies that suggest that olive oil may decrease the risk for dementia, type 2 diabetes, rheumatoid arthritis, and even cancer.
It even has anti-bacterial properties. One study showed that taking 30gm of extra virgin olive oil per day can eliminate a helicobacter pylori infection in 10-40% of people.
It is important to use extra virgin olive oil because it has the most anti-oxidants and bioactive compounds in it.
We have been told for years that consuming garlic and onions are good for our heart.
However, a study from 2007 showed no reduction in LDL or heart disease in people consuming either raw garlic or garlic supplements.
Onions appear to have more benefits on lower cholesterol, primarily because they contain flavonoids such as quercetin. This study showed that quercetin from onions lowers LDL levels in overweight patients.
Consumption of several herbs have been shown to result in a mild or even moderate reduction in cholesterol levels.
These herbs include basil, artichoke, eggplant, fenugreek, arjun, genseng, and yarrow.
A systematic review published in 2003 showed a reduction in total cholesterol from the use of these herbs of up to 39%.
If you just have a hard time eating the good foods that can lower cholesterol levels, there are some supplements available that can help:
As discussed earlier, fish oil can substantially lower triglyceride and VLDL levels.
However, many people do not eat much fish, so supplementation may be necessary.
Click here for my preferred brand.
If you are vegetarian, vegan, or have a sensitivity/allergy to fish, algal oil is a great source of omega-3. You can get it here.
Niacin is a naturally-occurring B vitamin that has been used to raise HDL cholesterol for years.
Studies have shown that taking niacin can raise HDL levels by up to 25%. It also lowers LDL by 5-20% and triglycerides by 20-50%.
However, I still believe niacin is a good choice (after dietary changes) for people who have low HDL and high triglycerides, or those who don't want to take a statin or who cannot tolerate statins.
Click here for my preferred brand.
Red yeast rice has shown in studies to reduce total cholesterol levels 16-31%.
Click here for my preferred brand.
Several essential oils can have an effect on your heart health and may help lower cholesterol levels.
Lavendar oils help lower anxiety and cortisol levels.
Cypress oil helps promote circulation and lowers cholesterol levels.
Rosemary oil is an antioxidant that helps stabilize blood sugar and reduces blood lipid levels.
The best way to use these is to add a few drops to a diffuser which allows you to inhale them gradually while breathing normally.
Aerobic exercises such as walking, jogging, cycling, and swimming are great for the heart, lungs, and stress level. They also helps lower lipid levels.
Resistance training such as weight-lifting has also shown to improve lipid profiles by increasing HDL and lowering total cholesterol and LDL.
Most of us have terrible sleep habits and poor sleep hygiene.
Not only does that make us tired and grumpy, studies show that sleep deprivation results in lower HDL levels and higher triglyceride and LDL levels.
Improving sleep is foundational to almost any health issue we could discuss. I have yet to meet a person that is chronically sleep-deprived that is healthy and feels good.
Developing good sleep habits is critical to improving your sleep. These include:
If you are doing all of this and are still having sleep issues, it may be necessary to try a supplement.
1. Melatonin - Melatonin does NOT make you sleepy. It simply helps you relax which allows the normal sleep cycle to progress. Take it at least 30 minutes before going to bed.
2. Travacor - If you are having a lot of stress, anxiety, and mood issues which are affecting your sleep, this may help. It contains a blend of taurine, L-theanine and 5-HTP which help regulate mood and promote normal sleep. Take it an hour before bedtime.
3. Kavinace Ultra PM - If you are still having problems getting to sleep or staying asleep, this supplement may be very helpful. It contains the same ingredients as Travacor but with the addition of melatonin and phenylbutyric acid which makes it even more powerful. Take it an hour before bedtime.
Lack of sleep is a form of stress, so you can expect that any other stress will have similar results on the body.
Sure enough, this study showed that stress results in lower HDL, higher LDL, and higher triglyceride levels.
Stress can be caused by mental, physical, or even spiritual issues.
It is important to remove whatever stresses that you can from your life. That may mean seeing a marriage counselor, or changing jobs, or avoiding certain people.
If you can't avoid all stress, there are still some things that you can do:
If you have been diagnosed with high cholesterol levels and want to lower then without taking a medication such as a statin, there are several things that you can do.
The cornerstone of treatment should be to change your diet. Sugar and refined carbs will need to removed as much as possible. You probably also need to reduce your alcohol intake and fast foods.
Increasing your consumption of fish, fruit, and vegetables can also be very helpful, as well as cooking with extra virgin olive oil and adding many healthy herbs and spices to your food.
Finally, like with almost any condition we could discuss, cholesterol levels will improve with regular exercise, improving your sleep and reducing stress.
Now it's your turn...
Have you been diagnosed with elevated cholesterol?
What you have tried in the past that works? What didn't work?
Leave any questions or comments below.
Dr. Whelchel is a family physician who specializes in functional medicine, especially hormone optimization. He has over 20 years experience in private practice managing patients with various medical issues. His passion is helping patients reach their full potential of wellness and quality of life. He grew up in the Texas Panhandle where he currently lives. He is married and has 3 awesome children.