Ask Well
I have high cholesterol, but when I tried statins, I didn't like the side effects. What are non-pharmaceutical ways to lower my cholesterol?
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People
with high cholesterol often fall into two groups: those whose levels are so
high that they need cholesterol-lowering medications like statins to reduce
their risk for heart disease; and those whose levels are elevated, but not so
high that they require medication, said Dr. Felipe Lobelo, a life-style
medicine researcher at Emory University in Atlanta.
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If
people in the latter group have an otherwise low risk for heart disease,
life-style changes should be their first step in trying to improve their
health, according to the American Heart Association.
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Your
cholesterol levels refer to a measure of two types of particles in your blood:
low-density lipoprotein (sometimes called "bad," or LDL) cholesterol
and high-density lipoprotein (often referred to as "good," or HDL)
cholesterol. When there's too much LDL cholesterol in your blood, it can gum up
your blood vessels, making it harder for your heart to pump blood through them.
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For
adults ages 20 or older, it's generally considered healthy for blood LDL
cholesterol levels to be under 100 milligrams per deciliter. If your levels
rise to 189 milligrams per deciliter but your risk for heart disease is
otherwise low, the A.H.A. says, it may be worth trying lifestyle changes to
bring your cholesterol down before you rely on prescription medication.
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Levels
above 190 milligrams per deciliter typically lead to a statin prescription.
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Certain
lifestyle tweaks such as getting sufficient sleep, reducing tobacco use and
managing stress can help improve cholesterol levels. But two lifestyle choices
in particular can yield much greater benefits, said Dr. Frank B. Hu, a
professor of nutrition and epidemiology at the Harvard Chan School of Public
Health.
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EXERCISE
When we exercise, HDL cholesterol is released into the bloodstream, where it
sweeps up fatty plaque deposits in the blood vessels and transports them to the
liver for disposal.
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The
A.H.A. recommends that all adults get at least 150 minutes of moderate
exercise, or 75 minutes of vigorous exercise, per week, Dr. Lobelo said. ?That can include walking, swimming, lifting
weights, dancing or whatever else you enjoy and can do without injury, he
added.
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The
key, he said, is to ensure that your heart rate is elevated enough. If you're
struggling to talk while you're exercising, Dr. Lobelo said, you know you're
working hard enough.
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Regular
exercise can help lower your cholesterol, particularly if you didn't exercise
before, Dr. Lobelo said. He added that it may take longer for some people to
improve their cholesterol levels through exercise than others. So if it's not
coming down immediately, don't get discouraged.
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DIET
Research suggests that a plant-forward diet called the portfolio diet - which
includes soy products like tofu and other plant-based proteins like beans,
lentils and chickpeas; viscous-fiber-containing foods like oats, barley,
psyllium husk, berries. apples and citrus fruits; nuts and seeds: avocado; and
healthy plant-based oils like canola and olive - can help lower cholesterol,
said Andrea Glenn, a nutrition researcher at New York University.
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In
a review of seven clinical trials that included about 440 participants who had
high cholesterol levels but who didn't require medication, researchers found
that the portfolio diet helped reduce their LDL cholesterol by up to 30
percent. That's about as effective as the older versions of statin drugs that
were widely used in the '90s, Dr. Glenn said.
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Dr.
Glenn and her colleagues followed about 210,000 U.S. adults for about 30 years
in a study published in 2023. They found that those who closely followed this
diet had a 14 percent lower risk of cardiovascular disease than those who ate
less of these foods, Dr. Glenn said.
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The
portfolio diet works because it combines various kinds of foods and nutrients
that help lower cholesterol in different ways, she said.
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Plant
proteins like beans, chickpeas and soy products, for instance, can inhibit the
production of apolipoprotein B, which normally helps your body take up
cholesterol from foods. Viscous fiber traps or binds cholesterol in the
intestines, making it harder to absorb. And nuts are good sources of
unsaturated fatty acids, plant sterols and fiber, which can all lower LDL
cholesterol levels.
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Even
adding or replacing a few foods - like adding nuts to your morning granola or
swapping red meat with chickpeas or tofu - can help improve your cholesterol,
Dr. Glenn said.
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"There's
certainly no magic bullet," Dr. Hu said. But diet, exercise and other
healthy habits can go a long way in helping to lower cholesterol. "We have
to think about it from a holistic point of view."
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Jyoti
Madhusoodanan
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