How to Lower Cholesterol
What to eat, what to skip, and how exercise fits in. A practical guide to improving your cholesterol numbers without guesswork.
Cholesterol is confusing. There is good cholesterol, bad cholesterol, triglycerides, and a bunch of numbers your doctor rattles off while you nod and pretend to understand.
Here is what actually matters. LDL is the problematic type (think L for Lousy). It builds up in artery walls and creates plaques that narrow blood vessels over time. HDL is the helpful type (think H for Helpful). It carries LDL away from arteries and back to the liver for disposal.
If your results got flagged, LDL is usually the number to bring down. The steps below are the lifestyle changes with the strongest research support behind them. They take consistency and a few months of patience.
Replace saturated fats with unsaturated fats
Start here. Of the dietary changes in this guide, this is the one that acts most directly on LDL. Saturated fat (found in butter, red meat, cheese, and full-fat dairy) raises LDL by slowing the rate at which your liver clears it from your blood. Unsaturated fats (olive oil, avocados, nuts, fatty fish) have the opposite effect. You do not need to eliminate saturated fat completely. The American Heart Association puts the target at 5 to 6% of daily calories for people with elevated LDL, which works out to about 13 grams on a 2,000 calorie day. USDA's What We Eat in America survey put only 34% of adults inside even the looser 10% ceiling, with the rest averaging 13.9% of calories from saturated fat. Closing that gap is one of the larger dietary levers available. Practically, that means choosing olive oil over butter, grilling chicken instead of steak a few nights a week, and snacking on almonds instead of cheese.
Add soluble fiber to your diet
Soluble fiber binds to cholesterol in your digestive tract and carries it out of your body before it can be absorbed into your bloodstream. The best sources are oatmeal, barley, beans, lentils, apples, citrus fruits, and Brussels sprouts. A 2023 dose-response meta-analysis of 181 trials and 14,505 people found that each extra 5 grams of soluble fiber a day lowered LDL by about 5.6 mg/dL, with the effect flattening out somewhere around 10 to 15 grams daily. Ten grams a day is a reasonable target, and pushing well beyond 15 buys little. Those trials mostly tested soluble fiber supplements rather than fiber from food, which is worth knowing before you buy a tub of psyllium husk on the strength of one number.
Eat omega-3 fatty acids regularly
Omega-3 fatty acids do not lower LDL. What they do is lower triglycerides and nudge HDL up. High triglycerides often accompany high LDL and independently increase cardiovascular risk. The best food sources are fatty fish like salmon, mackerel, sardines, and lake trout. Two servings per week is the standard recommendation. Plant sources like walnuts, flaxseed, and chia seeds contain a different form of omega-3 (ALA) that your body converts less efficiently, but they still contribute. If you do not eat fish, a fish oil supplement is an alternative, but check which omega-3 it actually contains. A systematic review comparing EPA and DHA found both lower triglycerides by 12 to 26%, while DHA raises LDL more than EPA does. On a page about bringing LDL down, that trade-off is worth raising with your doctor before you start taking one every day.
Exercise for 150 minutes per week
Moderate aerobic exercise (brisk walking, cycling, swimming, jogging) has a clearer effect on HDL than on LDL. A meta-analysis of randomized exercise trials put the average HDL gain at 2.53 mg/dL, rising by roughly 1.4 mg/dL for every extra 10 minutes per session, and estimated that it takes about 120 minutes of exercise a week before the effect shows up at all. The benefit runs through HDL itself, which is the particle that carries cholesterol out of the arteries and back to the liver for disposal. The Physical Activity Guidelines for Americans set the adult floor at 150 minutes of moderate activity per week, or 75 minutes of vigorous activity, which comfortably clears that threshold. That works out to 30 minutes five days a week. In that same analysis it was duration per session that drove the HDL gain, with no significant contribution from how often or how hard people exercised, so consistency over months beats occasional intense workouts.
Reduce processed and fried foods
Packaged snacks, fast food, fried foods, and commercial baked goods lean heavily on refined carbohydrates, and they were historically the main source of artificial trans fat. Trans fat is particularly damaging because it simultaneously raises LDL and lowers HDL. That route is mostly closed now. The FDA ruled that partially hydrogenated oils are no longer generally recognized as safe, and the final compliance date for selling through existing stock passed on January 1, 2021. Small amounts still occur naturally in meat and dairy. Refined carbohydrates (white bread, pastries, sugary drinks) raise triglycerides and promote the formation of small, dense LDL particles, which are more dangerous than large, fluffy LDL particles. You do not need to eliminate these foods entirely. Reducing them from daily to occasional makes a measurable difference.
Heads up: A "0g trans fat" label does not always mean none. FDA labeling rules let a product declare zero when one serving holds less than 0.5 grams. With partially hydrogenated oils out of the food supply that gap is far smaller than it used to be, but it still applies to the trans fat that occurs naturally in meat and dairy, and multiple servings add up.
Add plant sterols and stanols
Plant sterols and stanols are naturally occurring compounds that structurally resemble cholesterol. When consumed, they compete with cholesterol for absorption in your intestines, blocking some cholesterol from entering your bloodstream. Reviews of the clinical trials put 2 grams of plant sterols a day at an 8 to 10% LDL reduction, with the effect topping out around 3 grams a day. Going above that adds nothing. They are found naturally in small amounts in nuts, seeds, and vegetable oils. Some foods are fortified with them, including certain margarine spreads, orange juice, and yogurt drinks. Look for products labeled "contains plant sterols" or "heart healthy." The effect is additive to other dietary changes.
Cholesterol responds well to diet and exercise changes, but it does not respond overnight. Get your baseline numbers tested, make these changes consistently for 3 to 6 months, then get tested again. Lifestyle change alone is enough for some people and not for others, and there is no way to know in advance which group you are in. If your numbers are severely elevated or you have other risk factors (family history of early heart disease, diabetes, smoking), medication may be appropriate regardless of lifestyle changes. That is not a failure. It is your body's genetics. Lifestyle changes still help even when combined with medication.
Questions we get asked about this
Answers from experience, not a textbook.
Diet changes start moving blood lipids within a few weeks, but an early reading is noisy and easy to over-read. Three to six months of consistent change before you retest gives a number worth acting on. Some people are hyper-responders to dietary cholesterol changes and see large improvements quickly. Others have genetics that make their cholesterol more resistant to dietary intervention. The only way to know is to test.
For most healthy adults, no. The old guidance limiting dietary cholesterol to 300 mg daily has been dropped from current dietary guidelines. For most people, the cholesterol you eat affects blood cholesterol far less than the saturated fat you eat does. Individual response varies more than the older guidance assumed. That is not the same as no limit at all, and current advice points at your overall dietary pattern rather than at a per-day egg count. If you have existing heart disease or diabetes, discuss egg intake with your doctor, as these populations may be more sensitive.
Total cholesterol under 200 mg/dL is desirable. LDL under 100 mg/dL is optimal (under 70 for people with heart disease). HDL above 60 mg/dL is protective, and below 40 for men or below 50 for women is considered a risk factor. Triglycerides under 150 mg/dL is normal. Treat these as long-standing reference ranges rather than personal goals. Current AHA and ACC guidance bases treatment decisions on your overall cardiovascular risk rather than on hitting one number, so your doctor may work to different figures than these.
Yes, though not evenly across the three numbers. A review of weight-loss thresholds found triglycerides start improving once you lose 2 to 5% of your body weight and HDL once you lose 5 to 10%, while the LDL relationship is the weaker one. In the Look AHEAD trial, where average starting LDL was already 100 mg/dL, weight loss produced no LDL reduction at all. For someone weighing 200 pounds, losing 10 to 20 pounds is well worth doing for triglycerides, HDL and blood pressure, but do not count on it to move LDL on its own. Weight loss also reduces chronic inflammation, which independently contributes to cardiovascular risk.
Yes. Familial hypercholesterolemia is a genetic condition that causes very high LDL levels (often above 190 mg/dL) regardless of diet and exercise. CDC puts the prevalence of the heterozygous form at about 1 in 250, though a more recent meta-analysis it cites puts the global figure closer to 1 in 311. If your LDL is very high despite a healthy lifestyle, or if close family members had heart attacks before age 55 (men) or 65 (women), ask your doctor about genetic testing. People with this condition typically need medication in addition to lifestyle changes.
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How to Lower Cholesterol
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How to Lower Triglycerides