What are the 10 most effective ways to lower cholesterol?

If your doctor has told you that your cholesterol levels are high, you should take a good look at your diet and lifestyle and see what aspects could be improved.

Cholesterol is a unique type of fat with quite a complicated structure that is, contrary to popular belief, vital for our survival. Our body uses cholesterol to make bile acids; vitamin D; hormones such as estrogen, progesterone, testosterone, cortisol, and aldosterone; and the formation of new cells. However, too much cholesterol has been linked to atherosclerosis (hardening and narrowing of the arteries caused by a build-up of fat, cholesterol, calcium, and other substances) which increases our risk of a heart attack, stroke, and other cardiovascular problems.

If your doctor tells you your "cholesterol" levels are high, they mean that the levels of a range of different fat-like substances in your body are not within the normal range. Cholesterol tests measure:

• Total "cholesterol"
• Low-density lipoproteins (LDL) ("bad" cholesterol")
• High-density lipoproteins (HDL) ("good" cholesterol)
• Triglycerides.

Although there is often a genetic reason for your cholesterol levels being high, watching what you eat and exercising can make a difference to your LDL and HDL levels. Let's look at ten different ways to do just that!

1. Eat More Oats And Other Soluble Fiber

Soluble fiber acts like a sponge, absorbing water and turning it into a gel during digestion. It is also great at binding to cholesterol and removing it from the body, lowering overall cholesterol levels and ultimately the risk of heart disease.

Soluble fiber is found in several different foods such as:

• Apples
• Avocados
• Barley
• Beans and peas
• Brocolli
• Brussel sprouts
• Carrots
• Citrus Fruits
• Figs
• Flaxseed
• Guavas
• Oats
• Pears
• Potatoes and sweet potatoes
• Psyllium
• Stone and berry fruits
• Sunflower seeds.

To reduce LDL and total cholesterol levels, experts recommend eating at least 25 to 30 grams of fiber per day, with about one-quarter of that coming from soluble fiber sources. Three-quarters of a cup of cooked beans provides around 5 grams of soluble fiber, half an avocado contains 2 grams of soluble fiber and one cup of cooked carrots around 2.5 grams. Eat up!

2. Include More Plant Sterols or Stanols

Plant sterols and stanols (also called phytosterols) are found naturally in small amounts in fruits and vegetables, grains, legumes, nuts, and seeds. They are also added to some products such as cereals, cooking oils, granola, margarine, orange juice, and salad dressings in more significant amounts, and these products are often labeled as having "Cholesterol-lowering" benefits that are good for your heart.

But what are they? Plant stanols and sterols have a similar structure to cholesterol, and our digestive system finds it difficult to tell the difference between these and cholesterol. This confusion can prevent cholesterol from being absorbed into our bloodstream, which means it just gets excreted along with other body waste.

Studies show that sterols and stanols lower LDL cholesterol levels by an average of 6% and perhaps as much as 14% in as little as four weeks. Foods naturally high in sterols and stanols include almonds, apples, avocados, blueberries, Brussel sprouts, peanuts, pumpkin seeds, and tomatoes.

While everybody should add foods high in plant stanols and sterols to their diet, the American Heart Association recommends only people who have high cholesterol eat sterol and stanol-fortified products, with the aim to consume 2 grams of sterols or stanols per day.

3. Avoid Trans Fats

Since June 2018, trans fats have been banned by the FDA (Food and Drug Administration) as an ingredient in any new product, packaged, or made fresh in a restaurant. As long as a product contains less than 0.5% of trans fat, it can be labeled as zero trans fat in the United States. The World Health Organization wants the global elimination of artificial trans fats by 2023.

Trans fats are a by-product of partial hydrogenation of vegetable oil, which is a process that makes vegetable oils, which are normally liquid at room temperature, solid at room temperature, and spreadable. This process is inexpensive and also extends the shelf life of a product. But our body gets confused about trans fats because they are essentially unsaturated fatty acid that behaves somewhat like saturated fatty acid. Trans fats are stickier than other fats and levels of them can build up in the arteries and organs. They also make platelets stick together, predispose a person to blood clots, and inadvertently be incorporated into the cell membrane, which can cause holes to form in it. Researchers have discovered that people who eat diets high in trans fat are more likely to develop diabetes or suffer from a heart attack or stroke. In addition, their LDL levels were higher and their HDL levels lower than in people who ate hardly any trans fats.

Trans fats may still be found in some products and are usually listed on the label as partially hydrogenated oils.

4. Eat Monounsaturated And Polyunsaturated Fats

I can see you're thinking... " What??? Now you're telling me to eat fat", and we know it sounds confusing.

But not all fats are bad. We all need fats in our diet, just not in huge quantities. Monounsaturated and polyunsaturated fats are good for you, but all fats contain calories, so they should be eaten in moderation, preferably instead of saturated fats (more about saturated fats later).

Monounsaturated fats are liquid at room temperature and include vegetable oils (such as canola, high-oleic safflower, sunflower, olive, and peanut oils) and foods such as avocados and most nuts. The Seven Countries Study conducted during the 1960s revealed that people who ate a Mediterranean-type diet, which uses a lot of olive oil (high in monounsaturated fats), had a low rate of heart disease.

There are two main types of polyunsaturated fats, omega-3 fatty acids, and omega-6 fatty acids. Both types are involved in vital body processes such as blood clotting, inflammation, muscle function, cell membrane, and nerve formation. Fatty fish (such as mackerel, sardines, and salmon), flaxseeds, walnuts, canola oil, and unhydrogenated soybean oil are good sources of omega-3 fatty acids. Safflower, soybean, sunflower, walnut, and corn oils are high in omega-6. Polyunsaturated fatty acids have been associated with a reduction in the risk of heart disease and stroke, an increase in HDL, and a reduction in triglycerides. But they are also pro-inflammatory, and our typical Western diet has morphed away from being balanced in omega-3s and omega-6s (1:1) to unfavorably favoring omega-6s at a ratio of 16:1. Reasons for this imbalance include the practice of feeding animals corn and soya (which are high in omega-6s) instead of letting them graze (grass is high in omega-3s), and the use of oils high in omega-6s for cooking. A balanced ratio is critical for human development during pregnancy and lactation, and excess omega-6 intake can increase white adipose tissue and lead to chronic inflammation. Ensure your diet has a good balance of omega-3s and omega-6s.

The jury is still out regarding the health benefits and risks of saturated fats. Saturated fats are common in the American diet and include animal products such as red meat, milk, and cheese, and also foods such as coconut oil and many commercially prepared baked goods. Saturated fats can increase your LDL levels; however, they also increase HDL levels and decrease triglycerides. Until more is known about the risks and benefits of saturated fats, it is best to replace them with monounsaturated and polyunsaturated fats.

5. Lose Weight

Over 36% of Americans are obese and another 32% are overweight. People who are obese, particularly those whose weight is concentrated around their abdominal area, have higher rates of cardiovascular disease, depression, diabetes, cancer, liver and kidney disease, osteoarthritis, sleep apnea, and depression. They are twice as likely as normal-weight people to have high levels of LDL cholesterol, triglycerides, and low levels of HDL cholesterol.

Even an 8% weight loss can lower cholesterol levels and have a dramatic impact on your risk of cardiovascular disease and improve your quality of life. Diets that reduce portion size, and substitute saturated fats for monounsaturated and polyunsaturated fats, as well as eating foods that help reduce cholesterol are easy to instigate and maintain. Research has also shown that weight loss achieved by exercise can be even more effective at increasing HDL levels (good cholesterol) compared with dieting.

Talk to your doctor or a dietician about what weight-loss plan is best for you.

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6. Exercise

It's a fact, humans have got lazier. More than a quarter of the world's population doesn't do enough exercise putting them at risk of heart disease, diabetes, dementia, certain types of cancer, and other serious diseases.

The bare minimum everybody should do is 30 to 40 minutes, at least three to four times per week. Preferably, 60 minutes, every single day, is what we should aim for.

Exercise increases levels of HDL cholesterol (the good cholesterol) and decreases triglycerides. It also helps with weight loss and boosts your immune system. Aerobic exercise (cardio) and resistance training are the most beneficial. But you need to do it at a level that makes you sweat and increases your heart rate. On most days, exercise should be of moderate intensity such as:

• Brisk walking (three miles an hour or faster)
• Playing tennis (doubles)
• Mowing the lawns or cutting a hedge
• cycling (less than 10 miles an hour).

On at least one day a week, do something a bit more vigorous, such as:

• Jogging, running, racewalking
• Playing tennis (singles)
• Swimming laps
• High-intensity gym classes
• Fast cycling (more than 10 miles an hour).

Mix it up, so exercise becomes something you look forward to doing. But make sure you run it past your doctor first before you embark on anything too strenuous.

7. Don't Drink Alcohol

Remember the research that reported how great red wine was for your heart? Well, there was a lot they didn't tell you (including the fact that a lot of the studies that showed beneficial effects were sponsored by alcohol companies!).

For a start, only SMALL amounts of alcohol (less than one standard drink per day) have been found to increase HDL (good cholesterol) and decrease the clotting ability of the blood. Secondly, benefits are limited to people over 45. Thirdly, flavonoids and antioxidants responsible for these benefits are just as easily obtained from fruits and vegetables.

Heavy drinking is BAD for your heart. It can lead to high blood pressure, heart failure, stroke, cardiac arrhythmias (out-of-sync heartbeats), and sudden death. It can contribute to obesity and increase the risk of certain cancers. Excessive drinking has been associated with increased LDL cholesterol and triglyceride levels, and lower HDL levels.

If you have never drunk alcohol, don't start. If you do already drink, try to cut down.

8. Improve Your Gut Health

We are only just beginning to understand how critical the organisms that live in our gut are for our overall well-being.

Our digestive tract is home to trillions of bacteria as well as fungi and viruses – these are known as the gut microbiome. The makeup of this biome is largely genetically determined; however, it is heavily influenced by several factors such as whether we are born naturally (vaginally) or by cesarean section, if we were breastfed, our use of antibiotics, and our exposure to chemicals, pesticides, and other toxins.

Research has already linked small imbalances in this microbiome to many common conditions such as Alzheimer’s disease, multiple sclerosis, rheumatoid arthritis, and Type 2 diabetes. Preliminary studies also suggest it has a significant influence on triglyceride and HDL levels as well, in addition to our potential for weight gain.

To improve your gut microbiome, start by minimizing your intake of sugary, processed, or fatty foods. Base your diet around whole fruits and vegetables, whole grains, legumes (such as beans), and soluble fibers such as oatmeal. Fermented foods such as kimchi, sauerkraut, and tempeh are rich in probiotics and easily digested, and in small amounts boost the numbers of good bacteria in your gut. Supplemental probiotics can be beneficial especially if you need to go on antibiotics to treat a serious infection.

Say yes to a little dirt. Studies have shown people who garden, handwash dishes, own a dog, or forgo chemical-based disinfectants for more natural cleaning products such as citric acid are generally healthier than those who are strict with their cleanliness.

9. Stop Smoking If You Smoke

If you are a smoker, then you probably already know all the reasons why you shouldn't smoke.

But did you know that if you are a smoker with high cholesterol, and a close family member (such as your father or mother, brother or sister) already has heart disease, then you have a ten times greater risk of developing heart disease than somebody with normal cholesterol who doesn't smoke?

Smoking is hard on your arteries. It damages their lining, leading to inflammation which increases the build-up of plaque - plaque is a waxy substance composed of cholesterol, fibrin, and calcium that narrows your arteries, making it harder for your heart to pump blood around your body.

Smoking also increases LDL and triglyceride levels. At the same time, it lowers HDL cholesterol levels. But research has shown that within a few weeks of quitting, HDL levels have mostly returned to normal in ex-smokers. Within a few years, your risk of a heart attack has also decreased significantly.

We all know quitting is hard, so gather up some support and take advantage of several free resources available, such as:

• 1-800-QUIT-NOW: Free phone-based service with coaches and referrals to local resources
• Smokefree.gov: Web-based quit-smoking advice
• 1-800-DÉJELO-YA (1-855-335-3569): en Espanol.

10. Follow Your Doctors Advice About Taking Cholesterol-Lowering Medications

Statins, also known as HMG-CoA reductase inhibitors, are the most common medications used to lower cholesterol. Examples include atorvastatin (Lipitor), simvastatin (Zocor), and rosuvastatin (Crestor).

They are very effective at lowering cholesterol and work by inhibiting an enzyme involved in the making of cholesterol in the liver as well as boosting the clearance of LDL cholesterol. Statins also may have other properties, such as reducing inflammation. Research has shown they can reduce the risk of heart disease in middle-aged people, but their benefits do not appear to extend to the elderly.

Before prescribing statins, or any other cholesterol-lowering medicine such as fibrates, ezetimibe, PCSK9 Inhibitors, Nexletol, Nexlizet, or Leqvio, a doctor will take into account how high your cholesterol level is, and what other risk factors you have for cardiovascular disease. Statins and other agents are not without their side effects, so the benefits for you must outweigh the risks.