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High Cholesterol: Lifestyle Management

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This information was reviewed and approved by Howard D. Weinberger, MD, FACC (7/1/2019).

Managing Cholesterol to Keep a Healthy Heart

Milk and cheeseCholesterol is, in fact, a necessary building block for producing hormones, cellular membranes and digestive acids. However, the vast majority of us eat foods with significantly more cholesterol than we need. In fact, your body can make all the cholesterol it needs without eating any additional in your diet.

The most recent U.S. Dietary Guidelines for Adults, released in December 2020, suggest that we should eat a diet with as little cholesterol as possible, because it is not needed and can be manufactured by the body.


What is Cholesterol?

Cholesterol is largely derived from foods that contain fats and animal products — such as dairy (including cheese), fish and shellfish, meats of any kind, eggs and poultry.

Cholesterol, as we refer to it, is composed of three different groups that make up your lipid profile: 

  • LDL (low-density lipoproteins or "bad" cholesterol)

  • HDL (high-density lipoproteins or "good" cholesterol)

  • Triglycerides

High LDL, low HDL and elevated triglyceride levels are all associated with plaque development in the arteries, which can lead to heart attack and stroke. Certain cholesterol-lowering medications are generally safe and effective. However, a heart-healthy lifestyle, including a healthy diet and exercise can significantly reduce your cholesterol levels, in some cases in place of medication.


Top 10 Tips to Improve Heart Health:

1. Avoid Bad Fats.

Saturated, polyunsaturated and trans fats all raise LDL ("bad" cholesterol) levels. Saturated fats are found mainly in animal products and tropical oils. Trans fats are typically found in margarines, baked goods or anything containing "partially hydrogenated vegetable oil.” One often overlooked source of trans fats is many “nondairy” products. Because the amount of trans fats are below the officially reportable amount, the package usually lists “0,” which may not be true. Surprisingly, dietary fat intake may have a greater impact on blood cholesterol levels than cholesterol itself.

Did you know that two slices of bacon have 17 grams of saturated fat?

Reduce or avoid bad fats:

  • Red meat

  • Whole milk, butter and cheese

  • Tropical oils (coconut, palm and other tropical oils)

  • Trans fats or partially hydrogenated vegetable oil

  • “Nondairy” products

Watch the fat calories you eat every day:

  • Fats — less than 25 to 35 percent of total caloric intake (American Heart Association [AHA] recommendation)

  • Saturated fat — less than 7 percent (AHA recommendation) to 10 percent (2016 U.S. Dietary Guidelines)

  • Trans fats — less than 1 percent (AHA recommendation)


2. Increase Good Fats.

There are positive benefits of eating "good fats" that are best demonstrated by the Mediterranean diet or whole food plant-based diets, which are low in saturated fats. Mono- and polyunsaturated fats, such as those found in olive oil, canola oil and nuts, can be particularly beneficial to your lipid profile. There’s even some evidence that one brazil nut a week may help to lower the LDL bad cholesterol.

Eat these good fats:

  • Olive and canola oils

  • Walnuts and almonds — high in calories, but a handful can help lower bad cholesterol


3. Eat Omega-3 Fatty Acids.

Omega-3 fatty acids can lower triglycerides. Since omega-3 fatty acids are not produced by the body, we are dependent on exogenous sources, which can be marine sources (salmon, herring and fish oil supplements), plant sources (soy, canola, flaxseed oils, walnuts and flaxseeds) which are rich in the healthiest omega-3s, EPA and DHA.

  • Plant-based sources of omega-3s are recommended, as they are lower on environmental impact than marine sources which can sometimes be contaminated with heavy metals, PCBs, and other common marine toxins.
  • Two servings of fatty fish per week (salmon, mackerel, herring, lake trout, sardines and albacore tuna; some fish are quite high in cholesterol). Avoid fish with high levels of heavy metals (such as mercury) and pesticide residues (AHA).
  • Flaxseeds and walnuts may be the easiest way to regularly add omega-3s into your diet.
  • Use soy, canola and flaxseed oil.
  • Plant sources of omega-3s are preferred over fish oil capsules.


4. Increase Your Fiber Intake.

Soluble fiber lowers the absorption of cholesterol in the intestines. It’s not just eating more fruits and vegetables, but rather replacing the high fat, high cholesterol food items with those that are low fat and low cholesterol. A cheeseburger with bacon piled high with veggies is still not a healthy choice.

Consuming more fruits and vegetables is not only associated with lower cardiovascular disease risk, but can also reduce risks of certain cancers and can even affect energy levels, performance and bone density.

  • Eat at least 25 to 30 grams of soluble fiber a day.

  • Oatmeal: A cup and half of cooked oatmeal contains six grams of fibers.

  • Soluble fiber sources: bran, bananas, kidney beans and vegetables.


5. Exercise Every Day.

Exercise can raise HDL approximately 5 percent within two months of starting a program, while lowering triglycerides. Increasing your HDL can in turn lower your LDL. Moderate-intensity, aerobic activity is best. Remember to consult your doctor before initiating an exercise program.

Aim for:

  • 30 minutes/day, five days/week

  • Strength training at least two days/week to maintain muscular endurance


6. Lose Excess Weight.

Excess weight lowers HDL and raise triglycerides; weight loss tends to raise HDL and lower triglycerides.

7. Quit Smoking.

We all know that smoking is bad for your heart. What you may not know is that smoking lowers HDL, which in turn can raise LDL.

8. When Needed, Use Margarine with Plant Sterols/Stanols.

It was not that long ago that margarine was loaded with trans fats. Trans fats are felt to be so unhealthy that New York City now outlaws their use in restaurants. Many margarines are now not only trans fat-free but also contain heart healthy plant stanols and sterols. Plant sterols and stanols (essential components of plant membranes) are structurally similar to cholesterol, thereby reducing intestinal absorption of cholesterol.

  • Two grams a day, or roughly two tablespoons/day of a sterol/stanol-enriched butter-substitute can lower LDL by 5 percent to 15 percent
  • Use these instead of butter, but since they are high calorie, don’t overdo it!


9. Watch the Alcohol.

The information surrounding alcohol and heart disease can be confusing for patients and doctors alike. On the one hand, alcohol (in moderation) can raise HDL while reducing the risk of heart attack and stroke. However, significant alcohol intake can fuel high triglycerides (and even be linked to high blood pressure) and cause liver problems, particularly if you take cholesterol-lowering medications.

If you have high triglycerides, it's best to minimize if not avoid alcohol altogether.

10. Take Cholesterol Medication If Prescribed.

Cholesterol medications are not just for high cholesterol patients. In fact, patients with normal cholesterol may still benefit from cholesterol medication. Plaque development in the arteries is an inflammatory disease. Certain cholesterol medications may lower the risk or development of this disease process. The latest guidelines for treating high cholesterol focus now on one’s overall cardiovascular risk rather than specific numbers.

The best way to lower your risk is to exercise; eat more plant-based; reduce stress; maintain a healthy weight and blood pressure; and, of course, avoid smoking.

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