Cholesterol gets some negative publicity, but it’s not inherently “bad”. While high cholesterol is associated with heart attacks and strokes, your body also needs cholesterol for cell membranes, making hormones (such as estrogen, testosterone, and adrenal hormones), digestion and vitamin synthesis. 

HDL (“good cholesterol”),  LDL (“bad cholesterol”), and total cholesterol are routinely measured to gauge heart health.  Ideally, LDL cholesterol levels should be under 100 mg/dL, and while medication is one solution, you can also lower it naturally through diet and lifestyle changes. Before discussing these science-backed strategies in more detail, let’s start by examining what cholesterol is and how to interpret your results.

What is cholesterol?

Cholesterol is a waxy substance in your blood that is used to create new cells, hormones, and vitamin D. While you can get cholesterol from the foods you eat, your liver produces all the cholesterol your body needs [13]. 

Although cholesterol serves several important functions, high (total) cholesterol is a risk factor for heart disease. Total cholesterol is calculated by measuring LDL and HDL cholesterol levels, as well as triglycerides.

LDL stands for low density lipoprotein and is often referred to as “bad” cholesterol because it accumulates in your blood vessels and increases your risk for heart disease, stroke, and atherosclerosis (fat buildup in the arteries) [1]. Conversely, HDL stands for High Density Lipoprotein, and is considered “good” cholesterol because it picks up cholesterol and returns it to the liver for excretion [2]. 

Interpreting LDL results

Ideally, LDL levels should be less than 100mg/dL. Most healthy adults should get cholesterol levels checked every four to six years, but if you have heart disease, diabetes, or a family history of high cholesterol, you should get it checked more frequently [3].

Here’s how to interpret your LDL cholesterol level results [4]:

• <100 mg/dL: Optimal

• 100-160 mg/dL: Elevated

• >160 mg/dL: High

For those at risk for cardiovascular disease, it’s recommended to have LDL levels be below 70 mg/dl [14]. Check with your healthcare provider to discuss your cholesterol levels and, if necessary, decide on a treatment plan.

Factors that influence LDL cholesterol

If your LDL levels are high, you’re not alone, since almost one third of US adults also have high LDL cholesterol [5]. From diet and weight to genetics and lifestyle habits, there are many factors that influence elevated LDL levels.

Age

You can develop high LDL cholesterol at any age, but people are most frequently diagnosed between 40 and 59 years old [6].

Weight

Being overweight may raise the risk of high cholesterol and elevated  LDL levels. Studies show that losing 5–10% of body weight can reduce LDL cholesterol levels and losing 1-3% of body weight may improve HDL cholesterol levels [16,17].

Family history

Genetics can have a significant influence on your blood lipid levels. A condition called familial hypercholesterolemia makes it more difficult for your body to remove LDL cholesterol from the blood and break it down in the liver [6]. If you have a family history of high cholesterol, heart disease, heart attack, or stroke, it’s important to get your levels checked regularly [6,12].

Race and ethnicity

Asian Americans (including those of Indian, Filipino, Japanese, and Vietnamese descent) are more likely to have high LDL cholesterol than other racial ethnic groups [6].

Sex

Men between the ages of 20-39 are more likely to have higher total cholesterol levels than women. However, after menopause, women often see a rise in LDL levels, and are more likely to die from heart disease and stroke than from breast cancer [14]. 

Poor diet

Eating a diet rich in saturated fats, added sugar, and/or trans fat can increase your LDL cholesterol levels [6]. Conversely, reducing added sugar and processed foods and switching to healthy fats like olive oil, fatty fish and avocado, can help lower LDL. 

Lifestyle habits

Smoking cigarettes, not getting enough exercise, drinking too much alcohol, and experiencing high stress can all contribute to elevated LDL levels [6]. 

How to reduce LDL cholesterol without medication

Though medications (such as statins) are one way to lower your LDL cholesterol, many people successfully decrease their levels through diet and lifestyle modifications instead. Here are some science-backed methods to lower LDL cholesterol without medication.

Reduce saturated fats

Animal fats (such as butter, full-fat dairy, and fatty meats) are rich in saturated fat, which is known to contribute to increased LDL cholesterol levels. For improved heart health, reduce saturated fat intake to < 5-6% of total daily calories to lower cholesterol build up in the bloodstream [19]. You can do this by replacing saturated fats with plant fats (such as olive oil, avocado and nuts), and eating small, fatty fish (such as salmon, sardines, and trout) at least twice a week [7,9]. 

Avoid trans fats

Trans fats can increase the liver’s production of very low density lipoprotein (vLDL) [20]. They are mostly consumed from partially hydrogenated oils found in baked goods, margarine, shortening, and convenience/packaged foods. Trans fats have been shown to elevate LDL cholesterol and increase risk for cardiovascular disease, and therefore, should be avoided [9].

Increase fiber intake

Fiber binds to cholesterol particles and prevents them from entering the bloodstream. Aim to eat a total of 30-40 g of fiber-rich foods (such as veggies, fruit, whole grains, and legumes) per day, 5-10 g of which should come from soluble fiber [21]. Soluble fiber (such as oats, beans, and barley) can help reduce your risk of heart disease by absorbing cholesterol in the GI tract and lowering total and LDL cholesterol levels by 5-10% [8,9]. 

Replace dietary saturated fats with unsaturated fats

Polyunsaturated fats are preferentially converted in the liver into ketone bodies and transported to the tissues without leaving a trail of low density lipoprotein (LDL) [22,23]. To help lower heart disease risk, replace saturated fats with polyunsaturated fats (such as walnuts, flax seeds, and fish).

Stay active

Aerobic exercise can help lower LDL cholesterol, but evidence is even stronger for increasing HDL cholesterol and lowering triglycerides [10,11]. Exercise stimulates enzymes that help move LDL particles from the blood to the liver where it is excreted. Adults should aim for > 30 minutes of physical activity 5x/week (150 minutes of moderate-intensity or 75 minutes vigorous intensity aerobic activity per week), along with muscle-strengthening activity twice a week [5,24,25]. 

Limit refined carbohydrates

To reduce LDL levels, limit sources of refined carbs and added sugars such as soda, chips, candy, baked goods, sweetened yogurt, and ice-cream [15]. Some of these foods may also contain trans fat, which can increase LDL as well as inflammation [6,9].

Take supplements

In addition to eating a healthy diet, consuming plant stanols and sterols has been shown to lower total and LDL cholesterol up to 10% and 14%, respectively [18]. You can incorporate plant sterols and stanols with 2g/day in the form of food (such as vegetables, fruits, legumes, vegetable oils, nuts, and seeds) or a supplement.

Drink in moderation

If you have elevated LDL cholesterol, alcohol should be consumed in moderation. Excessive drinking is associated with elevated blood lipids, high blood pressure, heart failure or stroke, so alcohol should be limited to one drink a day for women and two drinks for men [9]. 

How long does it take to decrease LDL levels?

Evidence suggests that some people can see positive changes in LDL levels in as little as 4 weeks, however, the real-world response is often longer [11]. Moreover, response time varies depending on genetics, baseline levels and interventions - be patient and persistent!

Summary

LDL cholesterol is known as the “bad” cholesterol because it can accumulate in arteries, and is associated with heart disease and stroke. Many people struggle with high LDL cholesterol due to risk factors, including age, race, sex, genetics, and diet. Though medication is an option for lowering your LDL levels, there are many natural, evidence-based strategies to try instead. Replacing butter with olive oil, eating more soluble fiber (through fruits, vegetables, legumes, and whole grains), and getting regular exercise are all excellent methods to improve your LDL levels without medication. 

Disclaimer: The text, images, videos, and other media on this page are provided for informational purposes only and are not intended to treat, diagnose, or replace personalized medical care.