In this article, I am going to talk about all the different lifestyle techniques that you can use to try and lower your LDL (bad cholesterol). As a cardiologist in Singapore, we never look at cholesterol in isolation. Your cholesterol is just one component that adds to your overall risk of heart attacks and strokes. Examples of other components or, “risk factors” are smoking history, blood pressure, blood sugar, weight and family history. We look at all your risk factors and work out your risk level. Sometimes if you are low to moderate risk then it is reasonable to try lifestyle first before commencing cholesterol lowering medications called statins. However, some patients actually need to start medication straight away because their cholesterol, or their risk, is considered high. This conversation will happen between you and your doctor. If you have decided to try lifestyle modification first, then this article, shows you what can you do.
Eliminate dietary trans fats (partially hydrogenated vegetable oils)
LDL cholesterol is the most important when it comes to cardiovascular risk. If you want to lower it, the first thing that you can do is avoid dietary trans fats. These fats are already banned in some countries. They are common in junk food, margarines, or are used for cheap reusable frying oil. If you look at an ingredients list they are called partially hydrogenated oils. They are chemically altered vegetable oils and they raise LDLAND lower HDL (good cholesterol) AND consequently increase the risk of cardiovascular disease like stroke and heart attacks.
Reduce your saturated fat intake
The second step is probably to reduce your saturated fat intake, if you eat a lot of it. There are a whole load of articles about how fats are not the enemy they were once thought to be. I am not saying go low fat or eliminate saturated fats from your diet completely. Just make healthier fat choices. The fact is that saturated fats do increase your LDL. In addition, around 10% of people in the population respond more to saturated fats than others, i.e. the effect on their LDL is greater. For example, I tried bulletproof coffee for about a month (coffee with a lot of saturated fat – butter and coconut oil) and I managed to increase my LDL by about 30%!!I would suggest cutting back a little bit on the saturated fat and replacing it with a healthier fat like extra virgin olive oil. Olive oil has been shown to reduce the risk of heart attacks and death.
Increase your fiber intake
Basically, the more fiber you eat, the less cholesterol you will absorb in your diet. Whilst I’m on this subject, I should say that most cholesterol (80%) in your body is actually made by your body. Only a small amount of cholesterol comes from your diet. That is why increasing your dietary fiber intake will help you lower your cholesterol, but only by a small amount.
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Plant phytosterols (try not to use)
These compounds are basically plant cholesterol. They occur naturally in vegetables. The average person eats between 250 and 500mg per day in their diet. When you eat them, you block the absorption of cholesterol in the gut. They lower your LDL a little bit; if you take 2g per day, your LDL will fall by 7-10%. However, no studies have shown whether they reduce the risk of cardiovascular disease. My advice would be to avoid their use given the theoretical downsides with their use, read this article for more detail.
Red Yeast Rice
Another natural way to lower LDL is to take a supplement called red yeast rice. It can be bought in many different health foods stores. The reason why it lowers LDL cholesterol is that it contains a substance called monacolin K which is very similar to the statin drugs the doctor gives you. Nutraceutical supplements are generally not regulated so if you buy red yeast rice, you can never be sure how much is in each tablet. Get more information in this article. You are almost as well taking a statin drug, at least then you know how much you are taking!
If you are very overweight and if you lose weight, your LDL will come down a little bit. For every 10Kg of weight loss you can lower LDL by 0.2mmol/l or 8mg/dl. Losing weight has many other remarkable benefits on multiple risk factors like blood pressure so you don’t just do it for its cholesterol lowering properties!
In summary, there are multiple things you can do to lower your cholesterol that don’t require drugs. However, lifestyle changes only ever influence your LDL by 10-20%. Whereas medical therapy can lower it over 50%. The magnitude of reduction is reflected in the magnitude of the reduction in risk of heart attack and stroke. In addition, if you do make lifestyle changes you need to make sure that they are sustainable in the long-term. Three months of lifestyle adjustment is not going to lower your risk, any changes need to be long-term!
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Dr Michael MacDonald is a heart doctor and cardiologist working in Singapore.