Can I lower my cholesterol without taking a statin?

I have high cholesterol, but when I tried statins, I did not like the side effects. What are non-pharmaceutical ways to lower my cholesterol?

People with high cholesterol often fall into two groups. There are those whose levels are so high that they need cholesterol-lowering medications such as statins to reduce their risk for heart disease. And there are those whose levels are elevated, but not so high that they require medication, said Dr Felipe Lobelo, a lifestyle medicine researcher at Emory University in Atlanta.

If people in this latter group have an otherwise low risk for heart disease, lifestyle changes should be their first step in trying to improve their health, according to the American Heart Association (AHA).

Why your cholesterol levels are important

Your cholesterol refers 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 is 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.

For adults ages 20 or older, it is generally considered healthy for blood LDL cholesterol levels to be under 100 milligrams per deciliter. If your levels rise to as high as 189 milligrams per deciliter, but your risk for heart disease is otherwise low, the AHA says, it may be worth trying certain lifestyle changes to bring your cholesterol down before relying on prescription medication.

Levels that exceed 190 milligrams per deciliter typically lead to a statin prescription.

Non-drug alternatives

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 T.H. Chan School of Public Health.

One is exercise. When people 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.

The AHA recommends that adults get at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise, a week, Dr Lobelo said. That can include walking, swimming, lifting weights, dancing or whatever else you enjoy and can do without injury, he added.

The key, he said, is to ensure that your heart rate is elevated enough. If you are struggling to keep up your end of a conversation while exercising, Dr Lobelo said, that means you are working hard enough.

Regular exercise can help lower your cholesterol, particularly if you did not exercise before, Dr Lobelo said. But he added that it may take longer for some people to improve their cholesterol levels through exercise than others. So if it is not coming down immediately, he said, do not get discouraged.

The other thing to consider is diet. Research also suggests that a plant-forward diet called the portfolio diet – which includes soya products such as tofu and other plant-based proteins such as beans, lentils and chickpeas; viscous-fibre-containing foods such as oats, barley, psyllium husk, berries, apples and citrus fruits; nuts and seeds; avocado; and healthy plant-based oils including canola and olive oil – can help lower cholesterol levels, said Assistant Professor Andrea Glenn, a nutrition researcher at New York University.

In a review of seven clinical trials that included about 440 participants who had high cholesterol levels but did not require medication, researchers found that the portfolio diet helped reduce their LDL cholesterol by up to 30 per cent. That is about as effective as the older versions of statin drugs that were widely used in the 1990s, Prof Glenn said.

Prof Glenn and her colleagues followed about 210,000 US adults for about 30 years in a study published in 2023. They found that those who closely followed this diet had a 14 per cent lower risk of cardiovascular disease than those who ate less of these foods, she said.

The portfolio diet works because it combines various kinds of foods and nutrients that help lower cholesterol in different ways, she added.

Plant proteins like beans, chickpeas and soya products, for instance, can inhibit the production of apolipoprotein B, which normally helps your body take up cholesterol from foods. Viscous fibre traps or binds cholesterol in the intestines, making it harder to absorb. And nuts are good sources of unsaturated fatty acids, plant sterols and fibre, which can all lower LDL cholesterol levels.

Prof Glenn said that adding or replacing a few foods – like adding nuts to your morning granola or swopping red meat with chickpeas or tofu – can improve cholesterol.

“There’s certainly no magic bullet,” Dr Hu said, but noted that 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.” NYTIMES