You googled “How to lower my cholesterol” and landed on the perfect educational blog.
“You’ve been told it’s high and must come down, but you also need to understand why it is important to do that. Without understanding, you won’t be motivated.”
The first three topics discussed in this blog before getting to ‘How to lower my cholesterol’ are a 1-minute read.
- Having your cholesterol tested accurately
- How often must I test my cholesterol
- Why do I have high LDL?
I urge you to breeze through them.
Also read: ‘Master Lipograms – How To Calculate Total Cholesterol And Is It Important? ‘
Also read: Cholesterol goal guidelines. How low must you go?
Use the table of contents to jump to the ‘how to’ if you are not interested in the ‘why’!
Having your cholesterol tested accurately
“Have your lipogram blood sample after fasting.”
This is important because:
- It ensures a comparable result every time you repeat the test.
- Cholesterol reference ranges are based on fasting results.
- Accurate readings help calculate accurate goals.
Fasting means that for at least 10 hours before the test. You should rest, have nothing to eat, and only water to drink. Fasting overnight is the easiest way of controlling these variables.
Do not eat from 22h00 the night before you have the blood drawn. Then, get to the laboratory at 08h00 on the morning of the test.
How often must I test my cholesterol?
This depends on your risk profile.
- Low risk – every year
- Moderate risk – every 6 months until LDL goal is achieved
- High/ultra-high risk – every 3 months until LDL goal is achieved
Why do I have high LDL?
Our bodies manufacture cholesterol and absorb it from our gut.
Let’s look at the reason for high LDL in more depth:
- Your body manufactures too much cholesterol. This is usually genetic and out of your control.
- You take in too much cholesterol. You have a say in your diet, so take control back!
- You eat too many sugars and refined carbohydrates, increasing LDL after conversion steps.
- Your HDL is low, and not enough cholesterol is removed from your body.
How to lower my cholesterol?
Simply put, you need to drop the bad LDL and boost your good HDL.
Also read: Master Lipograms to understand the bad LDL and good HDL.
And if you’ve read my blog on risk and cholesterol goals, you will realize that it is all about ratios. You must manipulate the lipogram components: HDL up, triglycerides and LDL down.
“I recommend prioritising diet and lifestyle changes before buying expensive OTC tablets or using prescribed medication with potential side effects.”
Decrease your LDL ∣ 6 tricks
“Would you like to hear the hard truth?
The only moderate to high-risk patients I have seen achieve their LDL goals with diet changes have become vegan.”
Truthfully, a plant-based diet is the only way to achieve a diet-controlled cholesterol goal.
Veganism is unrealistic for most of us, so follow the guidelines below while sticking to a mainly plant-based diet.
I refer a lot in this post to Dr Greger an expert in plant-based nutrition.
1. Cut out cholesterol-containing foods
In a nutshell, this includes most meats and dairy fats.
You should cut out:
- Lamb, pork, and processed meats
- Grain-fed beef
- Chicken (brown meat and skin)
- Butter and cream
- Full-fat milk, yogurt, and cheese
- Fast foods, including burgers, fried chicken, pizza, and french fries
- Cakes, pastries, biscuits, and pies
Rather eat:
- Fish
- Chicken breast (white meat contains less than half the saturated fat of brown meat)
- Grass-fed beef in moderation 1,2,
- Fat-free milk and fat-free yogurt
- Low-fat cheese in moderation
- Substitute butter with olive oil, nut spread, avocado, or hummus.
Generally, grass-fed beef and chicken breast portions should be 100g daily maximum.
2. Include foods in your diet that lower LDL
High Soluble Fiber
Eating foods that have a high soluble fiber content helps to decrease LDL. According to the National Lipid Association, ensure you have at least 5 to 10g daily.
Foods rich in soluble fiber include:
- oats;
- certain beans;
- barley and whole grains;
- pears, apples, figs, nectarines, guavas, and apricots;
- sunflower and flax seeds;
- carrots, turnips, and sweet potatoes;
- broccoli, Brussel sprouts; and
- avocado.
For an idea of how much of what to eat per day to achieve this goal, refer to this Healthline article.
Avocados get a special mention
Eat 4 Brazil Nuts once a month
Yes, you heard correctly! A novel idea.
Let Dr Greger explain the study to you.
3. Reduce your sugar, refined carbohydrate, and alcohol intake
LDL is increased by sugar, simple or refined carbohydrates, and excess alcohol.
They also cause inflammation. Find out why this is important to avoid in 6 Foods That Cause Inflammation.
What are refined carbohydrates?
They are grains that have had their husks removed and/or been finely ground, thus removing all the fiber. Examples are white pasta, white rice, and anything baked or made from white flour.
They are pure energy sources, converted instantly into sugars. If this glucose is not immediately utilized, converted into triglycerides. Increased triglycerides result in higher VLDL levels. 3,4
As discussed in ‘How To Calculate Total Cholesterol And Is It Important?‘, VLDL transforms into LDL after visiting the fat cells. Therefore, elevated VLDL means higher LDL levels.
Also read: How to control diabetes without medicine. The tips are also relevant to patients with high LDL.
4. Exercise more – Burn glucose and decrease triglycerides
Exercise burns energy in the form of glucose. Less unutilized glucose means lower LDL levels down the line.
For in-depth information, read the section on exercise in my hacks for managing diabetes at home.
5. The egg controversy
Eggs get a special mention. Read this section twice.
The fact is that eggs raise cholesterol.
In the past, patients with cardiovascular risk were advised to eat less than 3 eggs per week.
However, eggs have many positives. Consider the pros and cons.
Eggs are:
- rich in other dietary essentials,
- high in protein,
- easy to obtain and
- versatile in the way they can be prepared.
In summary, the benefits of eggs, in moderation, may outweigh the increase in cholesterol.
The British and New Zealand Heart Foundations have adjusted their guidelines accordingly. They agree that 6 to 7 eggs per week are acceptable for patients at risk of heart disease.
I disagree with this.
“I advise my patients to stick to a maximum of one egg every second day, roughly 3 eggs per week. Less is better.”
Your eggs should be:
- Boiled,
- poached, or
- dry scrambled.
You negate the benefits of eggs by frying them in butter with a side of bacon!
6. Medication
Prescribed medications
Statins
This class of drugs works by decreasing the production of cholesterol in the liver, thus lowering LDL. 5 They also act directly at the artery level, decreasing inflammation and plaque formation. 6
Statins are inexpensive, but possible side effects are raised liver enzymes and muscle pain.
Ezetimibe
Ezetimibe blocks cholesterol absorption from the intestine. 7 It is best combined with statins or as monotherapy in statin-intolerant patients.
Ezetimibe is expensive and, in South Africa, is not covered by most health insurance policies.
Over-the-counter health formulations
The natural products available for lowering cholesterol are low potency and usually expensive.
Red rice yeast, in my clinical experience, offers the best results and is readily available at health shops.
“I have seen red rice yeast give patients similar side effects as statins.
Two other reputable supplements are:
- Rychol – South Africa
- CholestAway – USA
“I reserve these for patients at low risk for vascular disease or statin-intolerant individuals.”
Increase your HDL ∣ Solution number 7
This blog post by Healthify Me is a fantastic read. It summarises what foods are great for boosting HDL.
“If you only choose one lipoprotein, focus on lowering your LDL; it trumps increasing HDL.”
Delicious cholesterol-friendly recipes
References
- Daley, C. A., Abbott, A., Doyle, P. S., Nader, G. A., & Larson, S. (2010). A review of fatty acid profiles and antioxidant content in grass-fed and grain-fed beef. Nutrition journal, 9, 10. https://doi.org/10.1186/1475-2891-9-10
- WebMD. (2022, September 13). Grass-fed beef: Is it good for you? https://www.webmd.com/diet/grass-fed-beef-good-for-you
- Lopez-Jimenez, F. (2022, June 17). VLDL cholesterol: Is it harmful?. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/high-blood-cholesterol/expert-answers/vldl-cholesterol/faq
- Sherrel, Z. (2021, March 4). VLDL and LDL: What’s the difference, causes, treatments. Medical News Today. https://www.medicalnewstoday.com/articles/vldl-vs-ldl
- Stancu, C., & Sima, A. (2001). Statins: mechanism of action and effects. Journal of cellular and molecular medicine, 5(4), 378–387. https://doi.org/10.1111/j.1582-4934.2001.tb00172.x
- Koh K. K. (2000). Effects of statins on vascular wall: vasomotor function, inflammation, and plaque stability. Cardiovascular research, 47(4), 648–657. https://doi.org/10.1016/s0008-6363(00)00146-2
- Sizar O, Nassereddin A, Talati R. Ezetimibe. [Updated 2023 Feb 5]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK532879/
