How to Lower Cholesterol with Nutrition

You most likely associate the word "cholesterol" with negative things. Nevertheless, cholesterol isn't always harmful. Cholesterol is essential for the body's synthesis of vitamin D, certain hormones, and cell membranes.

Different kinds of cholesterol exist. The kind of cholesterol that is frequently linked to detrimental health impacts is low-density lipoprotein, or LDL. 

Cholesterol is primarily classified as "bad" LDL (low-density lipoprotein) cholesterol and "good" HDL (high-density lipoprotein) cholesterol, along with triglycerides, another type of fat in the blood. HDL cholesterol helps remove LDL cholesterol from the bloodstream and transports it back to the liver for processing. The liver then breaks down the cholesterol and removes it from the body.

Heart Disease and Cholesterol

For decades, we believed that elevated “bad” LDL cholesterol played a role in heart health. More recent research suggests that the connection may be more complex than previously thought. Your risk for heart disease is more complex than just controlling your blood cholesterol levels. 

A 2019 study from the American Heart Association (AHA) shows that dietary cholesterol might not be as big a driver of heart disease risk as once thought. Findings from observational studies have not generally supported an association between dietary cholesterol and CVD risk. 

A new study called the CANTOS study (Canakinumab Anti-inflammatory Thrombosis Outcomes Study) was a big deal because it indicated that inflammation plays a big role in heart disease, even when cholesterol levels are low. The study proved that inflammation—not just cholesterol—drives heart disease.

Inflammation plays a more significant role. Inflammation damages the blood vessel walls and oxidises LDL, creating a very sticky oxLDL. As the blood vessels were damaged and inflamed, these LDL and oxLDL adhered to the damaged vessel walls in an attempt to aid in their repair. You must understand that LDL cholesterol plays a crucial role in body cell repair and maintenance. So, naturally, this is what they do.

Over time, in a chronically inflamed body, more and more LDL will be layered on. As inflammation continues to cause damage, the LDL particles will continue to adhere to the affected areas, causing a plague to form. Eventually, the plague grows bigger, blocking blood flow, and we have a clogged artery.

As the plaque gets larger, it can become unstable and potentially break free and travel along the blood vessels. This can get stuck places… the legs, lungs, brain, etc… causing a clot and causing ischaemia. Ischaemia can lead to life-threatening conditions like heart attacks and strokes.

Inflammation and its role in chronic, lifestyle diseases is a whole topic by itself. We will not dwell further on this topic for now. It will require another comprehensive write-up and I do intend to do this at a later date.

For now, let’s move to the causes of unhealthy cholesterol levels and how we can reverse this condition with lifestyle modifications and nutrition.

What can raise the risk for unhealthy blood cholesterol levels?

Genetics

Familial hypercholesterolaemia may result from mutations in the genes that regulate cholesterol levels. Such gene mutations can be inherited from one's parents. The mutations make your body inefficient in removing LDL cholesterol from your blood. If you and several members of your immediate family suffer from hypercholesterolaemia, this suggests that your genes may influence harmful cholesterol levels.

It is also intriguing to note that your ethnicity may affect your risk of high blood cholesterol as well. Studies have shown that non-Hispanic white people are more likely to have high levels of total cholesterol. Hispanic Americans are more likely to have lower levels of HDL cholesterol. Asians are more likely to have high levels of LDL cholesterol, and African Americans are more likely to have high levels of HDL cholesterol.

Unhealthy Lifestyle

Stress may raise cholesterol levels. Multiple studies have shown a positive correlation between high stress and high cholesterol. Stress indirectly raises cholesterol levels by triggering the release of hormones like cortisol and adrenaline and, in turn, can cause your body to make more cholesterol. 

Poor sleep hygiene can be another reason for elevated cholesterol levels. Researchers found that both too much and too little sleep have a negative impact on lipid levels. Too little sleep leads to high levels of LDL cholesterol and a lowered level of HDL cholesterol. In women, sleeping more than eight hours at night produced a similar negative result. Men were not as sensitive to oversleeping as women.

Trans fats increase LDL cholesterol while lowering HDL cholesterol. Trans fats are typically found in fried foods, baked goods, and processed foods. Trans fats can occur naturally in small amounts in meat and dairy, but the majority of trans fats consumed are artificially created through a process called partial hydrogenation of vegetable oils. Hydrogenation makes the vegetable oil solid at room temperature primarily for increasing shelf life, stability, and versatility in food production.

The U.S. Food and Drug Administration (FDA) determined that artificially created trans fats are “no longer recognised as safe" in foods and are no longer used in U.S. food production. 

The next time you go grocery shopping, check your food’s ingredients to avoid trans fats. Look for ingredients like "partially hydrogenated oil" or "hydrogenated vegetable oil" on food labels, as these are indicators of trans fats.

Lack of physical activity is linked to a higher risk of having unhealthy blood cholesterol levels. Exercise lowers cholesterol by increasing HDL cholesterol, which helps remove LDL cholesterol from the blood. Lack of physical activity lowers HDL cholesterol and the body can't keep up with removing LDL cholesterol from your vascular system, leading to an increase in LDL cholesterol.

Tobacco smoking has a terrible influence on the total health system of human beings, not only affecting the arteries or the lungs but almost all the functional systems of the body, from cell to cell. Various studies have indicated that tobacco decreases HDL cholesterol and increases total cholesterol, LDL cholesterol, and triglycerides in smokers. 

Alcohol can influence cholesterol levels both positively and negatively, depending on the type, amount, and individual metabolism. 

Here’s how alcohol can contribute to higher cholesterol - Alcohol is processed by the liver, where it is converted into triglycerides (a type of fat). Excessive alcohol consumption raises blood triglyceride levels, which can lead to higher LDL cholesterol. Alcohol also increases inflammation in the body, which makes LDL cholesterol more likely to oxidise and become "sticky," contributing to plaque formation in the arteries. 

On a more positive note, moderate alcohol consumption (especially red wine) has been associated with a slight increase in HDL cholesterol, mainly due to polyphenols like resveratrol.

However, the effect is minimal, and other lifestyle changes (like diet and exercise) have a much bigger impact on HDL levels.

Medical Conditions

How to lower an elevated blood cholesterol level naturally? 

This involves a comprehensive approach that includes nutrition, regular exercise, adequate sleep, stress management, and supplementation.

Nutrition

• Increase your soluble fibre intake. Soluble fibres help reduce cholesterol absorption in the bloodstream. Foods rich in soluble fibre include oats, beans, lentils, fruits, and vegetables.

• Choose healthy fats. Remove trans fats from your diet. Limit saturated fats and replace them with monounsaturated fats like avocados and olive oil. Increase intake of anti-inflammatory omega-3 fats by incorporating fatty fish like salmon and mackerel into your diet. Alternatively, you can opt to take fish oil supplements. For more supplements, I’ve listed various supplements that can assist in lowering cholesterol naturally.

• Limit consumption of processed meats. Processed meats, like sausages, bacon, and salami, often contain a significant amount of saturated fat. Overconsumption of processed meats and saturated fats can raise LDL cholesterol.

• Limit consumption of deep-fried foods. In some commercial kitchens, frying oil is used multiple times before being replaced. When oil is heated repeatedly at high temperatures (above 180°C), it undergoes structural changes. The intense heat alters the chemical bonds of unsaturated fats, converting some into trans fats. On top of this, each reuse further degrades the oil, increasing the formation of harmful oxidation byproducts (free radicals).

Exercise

• Engage in regular physical activity. Aim for at least 150 minutes of moderate-intensity aerobic exercise, such as brisk walking or cycling, per week.

Sleep and Rest

• Prioritise quality sleep. Aim for 6–7 hours of sleep per night. Take note that both too little and too much sleep can negatively impact cholesterol levels and overall heart health. 

Stress Management

• Chronic stress disrupts your hormonal system, resulting in elevated cholesterol levels. Take time for self-care. Engage in stress-reducing activities like meditation, deep breathing exercises, or yoga to manage stress. 

Alcohol Consumption

• Drink in moderation. Limit alcohol intake to one drink per day for women or two drinks per day for men. Excessive alcohol consumption can raise cholesterol levels and increase heart disease risk.
  
  The definition of moderate alcohol consumption varies by health guidelines but here’s a guide:
  ✔ Men: Up to 2 drinks per day
  ✔ Women: Up to 1 drink per day
  
  What is "one drink"?
  Beer: 12 oz (355 mL)
  Wine: 5 oz (148 mL)
  Liquor (spirits like whiskey, vodka, rum, gin): 1.5 oz (44 mL)

Smoking Cessation

• Quit Smoking. Quitting is the best option. Smoking not only affects your cholesterol level. It affects the whole body and all its functions. Stopping smoking can improve HDL cholesterol levels and benefit overall cardiovascular health. 

Weight Management

• Maintain a Healthy Weight. Losing excess weight can help lower LDL cholesterol and triglyceride levels while raising HDL cholesterol. citeturn0search4

Supplements to Lower Cholesterol

Use these supplements under medical supervision, especially if you're taking medication.

Plant Sterols & Stanols  

These compounds are structurally similar to cholesterol and compete with it for absorption in the intestines. As a result, they reduce LDL cholesterol levels by preventing dietary cholesterol from entering the bloodstream. A meta-analysis of 41 trials showed that intake of 2 g/d of stanols or sterols reduced low-density lipoprotein (LDL) by 10%. 

Soluble Fibre (Psyllium Husk, Beta-Glucan from Oats & Barley)  

Soluble fibre forms a gel-like substance in the gut that binds to cholesterol and bile acids, preventing their absorption and promoting their excretion. (Yes, bile acids are indeed synthesised from cholesterol in the liver). This forces the liver to use more cholesterol to make new bile acids, thereby reducing LDL cholesterol. Current nutrition guidelines recommend getting 20 to 35 grams of fibre a day, with at least 5 to 10 grams coming from soluble fibre. 

Omega-3 Fatty Acids (Fish Oil, Algal Oil, Flaxseed Oil) 

Omega-3s lower triglycerides by reducing their production in the liver. They also improve HDL ("good") cholesterol levels and reduce inflammation, which helps prevent plaque buildup in arteries. Omega-3s can lower triglycerides by 20–30% at doses of 2–4 grams per day. 

Red Yeast Rice  

Red yeast rice contains monacolin K, which is structurally similar to lovastatin, a cholesterol-lowering statin drug. It inhibits HMG-CoA reductase, the enzyme responsible for cholesterol production in the liver.  

Caution: Some products may contain inconsistent amounts of monacolin K and do not take this supplement if you’re taking a cholesterol-lowering drug. Taking both together can double the statin effect, leading to very low LDL levels, which may cause serious side effects.

Niacin (Vitamin B3)  

Niacin reduces the liver’s production of LDL and VLDL (very low-density lipoprotein) while increasing HDL cholesterol. It also lowers triglycerides by reducing fat breakdown in adipose tissue. Studies have indicated that niacin can increase HDL choletesterol by 15–35%.

Caution: High doses may cause flushing, liver toxicity, and insulin resistance, so high doses of niacin should be used under medical supervision.