High Cholesterol

Nutrition and lifestyle changes are the most important steps you can take to lower your cholesterol. With the right support, this can happen as quickly as days to weeks and reduce your need for medications like statins. Discover our scientifically-backed guide to cholesterol below.

Cases per year

94 million adults in the U.S. have total cholesterol levels higher than 200 mg/dL, 28 million of which have levels higher than 240 mg/dL 1

General frequency

38% of adults in the US have total cholesterol above 200 mg/dL 2

Risk

High cholesterol is major risk factor for heart disease, which is responsible for 1 in 4 deaths per year in the US.

Lowering cholesterol with lifestyle interventions

Almost uniformly, several patients of mine who adopted a plant rich diet improved their cholesterol levels, putting them at much lower risk of heart disease and strokes.

Dr Yashoda Bhaskar, who has seen the power of lifestyle medicine to lower cholesterol first-hand.

Podcasts

Top scientific research supporting our approach

Program focusing on nutrition, exercise, and stress lowers cholesterol levels

The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the Multisite Cardiac Lifestyle Intervention Program 

A study with 869 patients enrolled in a 3-month lifestyle intervention program found lifestyle changes dramatically improved their health. Specifically, reduced dietary fat intake, more exercise, and better stress management significantly lowered total cholesterol and LDL, the 'bad' cholesterol. Embracing these lifestyle changes as part of a program can effectively control cholesterol levels, critical for managing heart disease risk 3

More lifestyle counseling, greater cholesterol reduction

Dose-Dependent Effects of Lifestyle Interventions on Blood Lipid Levels: Results from the PREMIER Trial

This study reveals that engagement in lifestyle counseling sessions has a direct correlation with reductions in LDL cholesterol - the 'bad' cholesterol. For every increase of 10 counseling sessions, LDL cholesterol dropped by an additional 6.2 mg/dL. The lifestyle modifications included a balanced diet, exercise, and weight management. The study shows that while understanding the fundamentals of a healthy lifestyle is crucial, there is transformative power in ongoing support and accountability. 

Low-fat plant-rich diet significantly lowers body weight, total and LDL cholesterol levels 

A Mediterranean Diet and Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial

52 participants assigned to a low-fat plant-rich diet saw significant benefits for lowering total and LDL-cholesterol, which decreased 18.7 mg/dL and 15.3 mg/dL, respectively. These participants also benefited from an average weight loss of 6kg, and improvements in insulin sensitivity 4. Seven participants were able to reduce or discontinue lipid-lowering medications due to the plant-based diet; another 7 participants were able to reduce or discontinue their blood pressure medications during the study.

Plant-rich diets reduce LDL cholesterol levels by 35%  

Effects of plant-based diets on plasma lipids 

Scientists reviewed 27 scientific studies on dietary interventions for the lowering of low-density lipoprotein (LDL) cholesterol. They found completely plant-based diets were most effective for lowering LDL cholesterol levels compared to all other diets, with reductions of up to 35% 5

Find out more about cholesterol below

High cholesterol

High cholesterol (or hypercholesterolemia) is a type of hyperlipidemia, where your cholesterol levels are too high; specifically, you have too much LDL cholesterol and non-HDL cholesterol in your blood.

What is cholesterol?

Cholesterol is a waxy substance made in the liver. It’s not required in the diet, because the liver makes all the cholesterol we need. It’s an essential part of our cell membranes, and is needed to make hormones, vitamin D, and bile acids (that help to digest fat), all of which are essential for a healthy body. 

Cholesterol travels through our bloodstream attached to lipoproteins. These have specific proteins on their surfaces called apolipoproteins. Cholesterol is carried by different lipoprotein packages which make, for example, LDL-cholesterol and HDL-cholesterol.

Low-density lipoprotein (LDL) cholesterol is commonly known as the ‘bad’ cholesterol. It’s responsible for transporting cholesterol through the body and is the vehicle for cholesterol to be deposited in your arteries, leading to atherosclerosis, hence its bad reputation. Cholesterol can be carried by more, small LDL particles or fewer, large LDL particles. Small, dense LDL is more associated with heart disease risk as it increases the number of Apolipoprotein B (ApoB)-containing lipoproteins 6.

Symptoms 

High cholesterol has no symptoms.

Nonetheless, it’s important that they’re detected because high cholesterol levels, or more specifically high levels of cholesterol-carrying apolipoprotein B, are a cause of atherosclerotic plaque build up in your arteries. Atherosclerosis can lead to the development of coronary heart disease, and increases your risk of having a heart attack or a stroke 7. Raised LDL cholesterol levels, total cholesterol levels, and triglyceride levels are all factors that increase your risk of heart disease.

A blood test is the only way to detect if you have it, so it’s important to have regular blood work done and work on lowering your cholesterol if necessary, to avoid developing heart disease later down the line. 

Diagnosis 

Your doctor will check your cholesterol levels with a blood test called a lipid profile— this typically reports the levels of: 

  • Total cholesterol 
  • LDL cholesterol 
  • HDL cholesterol
  • And triglycerides— a type of fat present in the blood

At Mora, we typically recommend an advanced lipid profile in addition to the traditional lipid panel. Most primary care providers are not ordering this more advanced test. This test allows our physicians and PAs to see the size and actual numbers of the different cholesterol particles which is extremely helpful in determining cardiovascular risk and the best treatment for you.

Treatment 

Maintaining healthy cholesterol levels is crucial for heart health, and the right nutrition is an effective tool in achieving this. Ideally, your total cholesterol should be below 150 mg/dL, and LDL cholesterol should be around 70 mg/dL or lower. These are the levels seen in populations largely free from heart disease, where the progression of atherosclerosis in our arteries is halted 8.

Our approach focuses on incorporating healthy nutrition habits centered around whole plant foods and high-fiber choices into your lifestyle. These foods naturally limit the intake of components that raise cholesterol levels, such as saturated fat and dietary cholesterol. At the same time, they provide an abundance of elements like fiber and plant sterols that aid in lowering cholesterol.

Alongside diet, we also emphasize the roles of exercise, adequate sleep, and stress management, as they can contribute to cholesterol control. Our team of lifestyle medicine experts is dedicated to helping patients not only reduce their cholesterol quickly but also sustain these healthy levels for the long term.

We believe in empowering you with the knowledge, guidance, and support necessary to make these life-enhancing changes. By letting food be your medicine and focusing whole-person health, you can take charge of your health today.

References  

1. Virani, S. S. et al. Heart Disease and Stroke Statistics—2021 Update: A Report From the American Heart Association. Circulation 143, (2021).

2. Tsao, C. W. et al. Heart Disease and Stroke Statistics—2022 Update: A Report From the American Heart Association. Circulation 145, (2022).

3. Daubenmier, J. J. et al. The contribution of changes in diet, exercise, and stress management to changes in coronary risk in women and men in the Multisite Cardiac Lifestyle Intervention Program. Ann. Behav. Med. 33, 57–68 (2007).

4. Barnard, N. D. et al. A Mediterranean Diet and Low-Fat Vegan Diet to Improve Body Weight and Cardiometabolic Risk Factors: A Randomized, Cross-over Trial. J. Am. Nutr. Assoc. 41, 127–139 (2022).

5. Ferdowsian, H. R. & Barnard, N. D. Effects of Plant-Based Diets on Plasma Lipids. Am. J. Cardiol. 104, 947–956 (2009).

6. Pencina, M. J. et al. Apolipoprotein B improves risk assessment of future coronary heart disease in the Framingham Heart Study beyond LDL-C and non-HDL-C. Eur. J. Prev. Cardiol. 22, 1321–1327 (2015).

7. Ference, B. A. et al. Low-density lipoproteins cause atherosclerotic cardiovascular disease. 1. Evidence from genetic, epidemiologic, and clinical studies. A consensus statement from the European Atherosclerosis Society Consensus Panel. Eur. Heart J. 38, 2459–2472 (2017).

8. O’Keefe, J. H., Cordain, L., Harris, W. H., Moe, R. M. & Vogel, R. Optimal low-density lipoprotein is 50 to 70 mg/dl. J. Am. Coll. Cardiol. 43, 2142–2146 (2004).

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