YouDoctors in Europe and America noticed something remarkable in the years after World War II: The incidence of heart attack or stroke dropped dramatically. Atherosclerosis is the buildup of cholesterol in your blood vessels that can cause cardiovascular disease. Autopsies performed during this period revealed a drop in atherosclerosis rates.
Experts were initially confused. But as time passed, many concluded that wartime food deprivations and the forced shifts in people’s diets—namely, big reductions in the consumption of red meat and other animal products—contributed to the heart-health improvements. Later work, particularly the famous Framingham Heart Study, helped establish that blood cholesterol levels, driven in large part by a person’s diet, tended to overlap closely with cardiovascular disease.
It was at the beginning a controversial idea to think that foods one eats can raise or lower cholesterol. While there’s ongoing debate about the relationship between red meat and poor health, the links connecting diet, cholesterol, and cardiovascular disease are beyond doubt.
Cholesterol (a waxy compound) is what your body uses to create hormones and strengthen the cells. “Our body needs some cholesterol for day-to-day functioning, but the amount our body needs is relatively small,” says Dr. Laurence Sperling, the founder and director of the Heart Disease Prevention Center at Emory University in Atlanta.
Different areas of the body contain cholesterol, including the brain, blood and heart. It’s the oversupply of cholesterol in the blood, specifically, that causes problems—specifically low-density lipoprotein (LDL), which is also known as “bad cholesterol. Too much LDL in the arteries can “form a fatty streak, which is the precursor of atherosclerotic plaque,” explains Dr. Francine Welty, a cardiologist at Beth Israel Deaconess Medical Center in Boston and former chair of the American Heart Association’s lipid committee. LDL is therefore the main building block for arterial plaque.
The two main diseases associated with clogged arteries—coronary artery disease and cerebrovascular disease—are both among the top three causes of death worldwide. These two diseases are responsible for more than one in four deaths worldwide. Managing or lowering blood cholesterol is an effective way to avoid these conditions. Sperling says ideal or “target” cholesterol levels vary depending on a person’s age, sex, and health status. However, the ideal goal is to maintain your LDL cholesterol under 70 mg/dL. While drugs can help people get there—and in some cases may be necessary—he says that non-pharmacological approaches are just as important. “Lifestyle and behavioral approaches are the foundation of cardiovascular prevention for all,” he says.
Experts share the best lifestyle choices to reduce cholesterol. They all agree that a healthy diet is the best.
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How to reduce cholesterol
The biggest trend in nutrition advice and diet is to stop referring specifically to micronutrients. Nutrition experts are now more focused on broad patterns for healthy eating. It means you should limit some foods but prioritize other food options, instead of trying to reach narrower goals.
“Something I tell a lot of my patients is that the Greek derivation of diet is Diaeta, which means a way of life,” Sperling says. “Dieting shouldn’t be torture, or something you maintain for a month. It should be a meaningful and purposeful change you can extend throughout your life.”
He says that one of the best changes you can make to your diet is to include lots of fruits and vegetables in your meals. Many of the most effective and evidence-backed cholesterol-lowering eating plans—like the Mediterranean diet—prioritize these foods, he says.
Meanwhile, reducing your intake of animal products—especially red meat and processed dairy foods—is a move that research has repeatedly tied to cholesterol improvements. “I’ve run the lipid prevention clinic at my hospital for 31 years, and the first thing we tell people is to lower their intake of saturated fats,” Welty says. She mentions red meat, butter, and dairy as foods people should aim to cut down on—not eliminate necessarily, but reduce—if they want to improve their cholesterol. Saturated fats are a common part of American life. They can be found in almost all meals, including eggs, dairy products, and red meat. This is an issue. “The Japanese have some of the lowest rates of cardiovascular disease in the world, and that may be because they eat much less red meat and saturated fat than we do in America,” Welty says.
It’s worth noting that saturated fat is a controversial topic in nutrition research. Experts have suggested that saturated fats are responsible for many health issues, including those caused by refined carbohydrate (such as sugary and packaged foods), processed meats and trans fats found in some fast food and packaged snacks. Others have argued that if people avoid meat and dairy but end up eating more processed or refined carbs, that’s an unhealthy trade. On the other hand, experts generally agree that trading saturated fats for some of the healthy foods mentioned above—such as fruits, vegetables, and nuts—is a highly effective way to improve your cholesterol scores and heart health. “If you decrease the saturated fat in your diet, that’s one of the best ways to lower LDL,” Welty says.
She adds that protein-rich soy-based products—from tofu to soy milks and yogurts—may also be good substitutes for meat, butter, milk, and other conventional saturated fat sources. “People in America are fixated on protein, but Americans don’t really like to eat soy products,” she says. This is unfortunate as soy has been linked to lower cholesterol and improved heart health for many decades. “If you need to replace saturated fats with other proteins, soy would be a good option,” she says.
Another good idea is to swap foods made with hooves with foods that have feathers and flippers. “Replacing red meat and pork with fish and chicken is something we often recommend,” Welty says. Particularly, heart-healthy options include salmon, mackerel and herring.
On the other hand, experts say fish oil—a popular health supplement—is not a helpful addition to your regimen. “Fish oil does not lower bad cholesterol,” says Dr. Leslie Cho, director of the Cleveland Clinic’s Women’s Cardiovascular Center. Doctors sometimes recommend prescription fish oil supplements to lower triglycerides. Commercial fish oil supplements can increase the risk of developing abnormal heart rhythms, so it is best to avoid them.
Last but not least, Cho says that getting plenty of fiber in your diet—something most Americans fail to do—is extremely important. “Fiber can bind to dietary cholesterol and eliminate it from the body,” she says. “We want you to aim for 25 grams of soluble fiber per day.” This is possible if you’re eating a lot of whole vegetables, fruits, and healthy whole grains like oatmeal or flaxseed. You can take supplements to help you achieve this goal. Cho says ground psyllium seed—sold under the brand name Metamucil, and also in less-expensive (but identical) generic products—is a helpful source of soluble fiber that can reduce your LDL levels.
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Non-diet approaches to Improvement of cholesterol
While lowering your LDL scores should be your primary focus, improving your levels of high-density lipoprotein (HDL) cholesterol—also known as the “good” kind of cholesterol—is also important. “HDL sucks cholesterol from blood vessels like a vacuum,” Cho explains.
You can boost your HDL by exercising. “It can raise your good cholesterol and also lower triglycerides,” another type of blood fat linked with cardiovascular problems, Sperling says.
The research on how to best increase your cholesterol is a mixed bag. The journal published a review of the studies in 2020. A Systematic Review, found that yoga has the strongest evidence in favor of its cholesterol-improving benefits. While many other types of exercise are undeniably good for your heart and vascular system—and some, like swimming and cycling, have been found to reduce cholesterol—more research is needed to determine which are the best at shifting cholesterol scores.
Some of Sperling’s research has also examined the benefits of intermittent fasting on cholesterol levels. While there are many forms of intermittent fasting plans, one of the most promising has been called time-restricted. This type of eating is a combination of both intermittent and regular fasting. A time-restricted diet involves eating a fast for between 12 and 16 hours every day. The rest of your day can be eaten as normal. Lunch, dinner, snacks, etc., can be eaten between noon and 8 pm. You must avoid caloric beverages and foods the rest of your day. Time-restricted eating has been linked to significant weight loss—which often improves cholesterol scores—as well as lower LDL and total cholesterol.
Other ways can you naturally lower your cholesterol. Experts say it is important to focus on the foods and exercise you do.
Don’t wait to start
While the health problems associated with high cholesterol and clogged arteries often don’t show up until a person’s 50s or 60s, the underlying plaque build-up often begins decades earlier—in some cases, during a person’s 20s.
Researchers found that making changes to your lifestyle earlier than you would expect can reduce the risk of developing cardiovascular disease. “The results of our study suggest that an effective primary prevention strategy may be to place greater emphasis on a healthy diet and regular exercise beginning early in life,” wrote the authors of a 2012 study in the Journal of the American College of Cardiology.
Sperling is in agreement. He suggests you think about cholesterol health similar to an investment portfolio. The sooner you start the better. “You want to start in your 20s, not your 40s,” he says.
Even if it’s too late to start early, the most important thing is to start. Cho states that changing your lifestyle or diet can help people who already have cholesterol-lowering drugs to prevent side effects like joint pain, muscle spasms, and other health problems. “If you can make changes that prevent you from having to increase your dose, that’s a good thing,” she says.
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High cholesterol is one of the leading risk factors for developing heart disease in older people. Drugs may not be an option, but improving your diet and fitness habits will help protect your heart and blood vessels from life-threatening dangers.
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