Lifestyle Modifications for High Cholesterol

Introduction

High cholesterol is a prevalent condition that significantly impacts cardiovascular health. It is advisable to manage this condition with lifestyle changes first.¹ 

As part of your treatment regimen, your doctor can suggest you start by practising the following lifestyle modifications, with or without medications:¹

• Eat food rich in omega-3 fatty acids
• Increase dietary fibres
• Eat food rich in antioxidants
• Reduce the consumption of food rich in saturated fats
• Eliminate trans fats
• Exercise regularly
• Manage your weight
• Stop smoking
• Limit your alcohol intake 
• Manage stress

Let’s explore specific lifestyle adjustments, practical tips, and evidence-based recommendations to guide you towards a heart-healthy way of living.

Understanding high cholesterol

Cholesterol is a fatty substance that is produced by your liver and can also be found in certain foods. A healthy body needs cholesterol to function, maintain healthy cells, and produce hormones, vitamins and enzymes. Too much cholesterol can damage your blood vessels leading to an increased risk of cardiac conditions, such as stroke, heart attacks and angina.

You may have heard of the “good” and the “bad” cholesterol”:²

• Low-density lipoprotein (LDL) is the “bad” cholesterol – it accumulates in your arteries. With time, it narrows and even blocks your arteries, leading to various heart problems.
• High-density lipoprotein (HDL) is the “good” cholesterol – it carries the cholesterol from your blood and arteries back to the liver where it is recycled and disposed of, reducing your risk of heart-related conditions.  

According to the British Heart Foundation, around half of the adults in the UK are living with high cholesterol. Having established the association between unhealthy cholesterol levels and cardiac disease, the leading cause of death in Europe including the UK, underlines the urgency of adopting lifestyle modifications to effectively manage cholesterol.¹ 

Lifestyle modifications

The American College of Cardiology emphasises the need for all patients to follow a heart-healthy lifestyle, for lifestyle modifications play a central role in the management of high cholesterol. Therefore, your doctor may suggest implementing some lifestyle changes first. These heart-healthy modifications might help you lower your cholesterol level and reach your target without the need for medications. The aim is to reduce LDL levels to guideline-recommended values and increase HDL levels.^1,5  

Heart-healthy diet recommendations

An essential step in cholesterol management involves adopting a heart-healthy diet, such as the Mediterranean diet or DASH. Below are effective and evidence-based tips to help you reduce your cholesterol level with dietary changes. 

Foods to include in your diet

• Foods rich in omega-3 fatty acids: Consuming fish regularly or taking omega-3 supplements was proven to have protective effects on your heart. Omega-3 fish oils do not decrease your LDL levels, however, they reduce triglycerides and improve your good HDL levels. It is advisable to consume fish high in fatty acids regularly (salmon, tuna and trout). You can also include vegetarian omega-3 sources (chia and flax seeds) in your diet ³ 
• Increase dietary fibres: Fibres, especially soluble fibre consumption, should be increased by aiming for at least 25 grams per day. Soluble fibres trap cholesterol in your gut, preventing their absorption, therefore lowering your cholesterol level. They are found in grains (oats, quinoa, barley), seeds (chia, flax), beans, many fruits (pears, figs, mangos, grapefruit, banana, berries, avocados), and vegetables (carrots, cabbage, okra, sweet potato, broccoli, Brussel sprouts)
• Foods rich in antioxidants: Vitamin A, C and E found in fruits and vegetables are essential to be part of your meals. Antioxidants defend our bodies by attacking and neutralising substances called free radicals, the molecules resulting from exposure to pollutants, stress, and certain foods.These rust your LDL cholesterol, which blocks your arteries and leads to more heart problems.⁴ 
• Plant sterols: These natural substances produced by plants decrease cholesterol absorption from your intestine and, therefore, lower total cholesterol and LDL levels. They are found in vegetable oils, fruits, vegetables, seeds, nuts and cereals.
• Food and oils that are rich in “good” mono and polyunsaturated fats: Canola, olive, sesame, sunflower, and soybean oils, nuts (walnuts, almonds, pine nuts) seeds (sesame, sunflower, flax, pumpkin), and avocados are some examples.
• Whole grains include oats, brown rice, whole grain bread, or tortillas
• Low-fat dairy products: This includes skimmed milk and low-fat cheese

Foods to limit or avoid 

• Reduce saturated fats: Saturated or “bad” fats are found in butter, ghee, lard, coconut and palm oil, red meats, fatty cuts of meat, chicken with skin, and processed food.
• Eliminate trans fats: Trans fats increase your LDL cholesterol and promote inflammation. They are found in packed and manufactured foods, including sweets, snacks, and fried foods. Read your labels and avoid foods containing “partially hydrogenated oil”
• Reduce processed foods: Because of their high saturated fat content
• Avoid fried and deep-fried food: Try grilling, baking, boiling or poaching instead
• Reduce red meat consumption: It is a source of saturated fat. Instead, eat chicken without skin and turkey 
• Stay away from full-fat dairy products
• Limit egg consumption: to egg whites or one whole egg per day, because all of the cholesterol is found in egg yolks
• Limit seafood: Although they contain omega 3, some are a source of cholesterol

Physical activity

The American Heart Association recommends a minimum of 30 minutes of moderate-intensity aerobic exercise at least five times a week.

Multiple studies have proven the beneficial effects of exercise on cholesterol levels. One of those studies assessed the results from 15 published investigations and confirmed the positive effects of regular exercise on cholesterol levels. Exercise increases HDL levels significantly and reduces total cholesterol. For optimal results, it is recommended to engage in aerobic exercises (such as running and cycling), resistance training (weightlifting, squats, plank, push-ups) or a combination of both.² 

Remember that being sedentary increases your risk of heart disease. Practising regular physical activity has many benefits to your heart, lungs and blood pressure, but most importantly, it manages your weight and indirectly lowers your bad “LDL” levels, total cholesterol and triglycerides. 

Weight management

Maintaining a healthy weight is directly associated with cholesterol management. Losing 3 to 5% of excess weight by following a healthier diet and increasing your physical activity can lower LDL, raise HDL levels and improve your cardiovascular health.^5,6

Smoking cessation

The harmful effects of smoking on cholesterol levels and your heart are well documented. Quitting smoking is not easy, but it is an essential and powerful step towards improving cholesterol levels and lowering your risk of heart problems. 

Limit alcohol intake

While moderate alcohol consumption might have some benefits, excessive drinking, more than two drinks per day for men and more than one for women, can contribute to high cholesterol levels. 

Stress management

Chronic stress can impact cholesterol levels by increasing LDL and lowering HDL. Adopting stress-reducing techniques such as meditation, deep breathing or exercising can improve cardiovascular health.^7,8 

FAQs

What are the risk factors associated with elevated cholesterol levels?

High cholesterol level is mostly caused by unhealthy lifestyle habits such as poor eating behaviours (a diet rich in saturated fats), leading a sedentary lifestyle and being overweight, smoking, consuming too much alcohol and stress. Also, the genes you inherit from your parents increase your risk of having elevated cholesterol levels. 

What are the signs of high cholesterol?

High cholesterol is a silent disease that does not show any symptoms. The only way to find out about your cholesterol level is to regularly see your doctor and have a blood test. 

How much time does it take for my cholesterol to go down?

You need to consult your doctor 12 weeks after initiating healthy lifestyle changes to assess if you have reached your target cholesterol level. If you haven’t, your physician might recommend adhering to a stricter diet or adding medication. 

What if lifestyle changes aren’t enough?

Sometimes lifestyle changes are not enough to lower your cholesterol levels and reach your target. Your doctor would, in this case, suggest adding a medication to your treatment regimen. You need to continue following these heart-healthy changes despite taking your medications. 

Summary

Regardless of your cholesterol level, lifestyle modifications are the foundation of cholesterol management. These include following a healthy diet, exercising regularly, managing stress, limiting alcohol consumption, quitting smoking and vaping and managing your weight. A heart-healthy diet involves focusing on fruits, vegetables, whole grains, dietary fibres, poultry, certain fish, and nuts while limiting full-fat dairy products, processed food and meat, and unhealthy oils. 

Exercise increases HDL levels, and decreases total cholesterol and triglyceride levels. Aim for regular aerobic or cardio exercises and resistance training (weightlifting and body weight).

Sometimes heart-healthy changes are not enough to normalise your cholesterol levels, your doctor will then recommend adding a lipid-lowering medication to your regimen. Remember to continue with the lifestyle modifications while taking your medication as prescribed.