How to lower cholesterol levels?

How to Lower Cholesterol

To effectively lower cholesterol levels, implement a comprehensive lifestyle approach including limiting saturated and trans fats to <7% of daily calories, increasing physical activity to at least 30 minutes 5 times weekly, consuming plant stanols/sterols (2g/day), and adding soluble fiber (10-25g/day). 1

Dietary Modifications

Fat Intake

• Reduce saturated fatty acids to <7% of total daily calories 1
• Limit trans-unsaturated fatty acids (found in partially hydrogenated oils) 1
• Replace saturated fats with:
  • Monounsaturated fats (olive oil, canola oil) 1
  • Polyunsaturated fats (corn oil, peanuts) 1

Cholesterol Intake

• Limit dietary cholesterol to <200 mg/day 1
• Reduce consumption of foods high in animal fats 1

Functional Foods

• Add plant stanols/sterols (2 g/day) to lower LDL cholesterol by 8-29 mg/dl 1
  • Available in margarine spreads and supplements
  • Must be consumed daily to sustain cholesterol reduction 1
• Increase soluble (viscous) fiber intake (10-25 g/day) 1
  • Sources include oat products, psyllium, pectin, and guar gum
  • Each gram of soluble fiber decreases LDL cholesterol by approximately 2.2 mg/dl 1

Other Dietary Components

• Increase consumption of fruits, vegetables, and whole grains 1
• Consider soy protein as a partial replacement for animal protein 1
• For individuals with hypertriglyceridemia >1,000 mg/dl:
  • Restrict all types of dietary fat except omega-3 fatty acids 1
  • Fish oil supplements containing EPA+DHA (2-4 g/day) may benefit those with resistant hypertriglyceridemia 1

Physical Activity

Exercise Recommendations

• Increase physical activity to at least 30 minutes per day, 5 times weekly 1
• For healthy individuals:
  • Moderate-intensity aerobic exercise at 70-80% heart rate reserve
  • Combined with low-intensity resistance training at 50% of 1 repetition maximum 1
• For individuals with elevated cholesterol:
  • Progress to 85% maximum heart rate for aerobic exercise
  • Combine with moderate to high-intensity resistance training at 75-85% of 1 repetition maximum 1
• Regular physical activity reduces plasma triglycerides and improves insulin sensitivity 1

Weight Management

• Achieve and maintain a healthy weight 1
• Even modest weight loss leads to decreased plasma triglycerides and lower LDL cholesterol 1
• Weight management is particularly important for individuals with abdominal (visceral) adiposity 1

Other Lifestyle Modifications

• Moderate alcohol consumption 2
• Smoking cessation 1, 2
• Monitor response to lifestyle changes every 4-6 weeks 1

When to Consider Medication

• If LDL cholesterol goals are not achieved after 12 weeks of therapeutic lifestyle changes 1
• Ezetimibe (10 mg daily) may be considered as an adjunct to diet to reduce elevated LDL-C when additional lowering is needed 3
• Statins remain the primary pharmacological treatment for elevated LDL cholesterol 1

Monitoring Effectiveness

• Evaluate LDL cholesterol response after 6 weeks of dietary changes 1
• If LDL goal is not achieved, intensify lifestyle modifications 1
• Continue to monitor adherence to therapeutic lifestyle changes every 4-6 months 1

Combining a healthy diet with weight loss and physical activity can increase HDL-C by 10% to 13%, contributing to an overall reduction in cardiovascular disease risk 2. The sum of dietary interventions can have a significant impact: step 1 diet (-10%), dietary fibers (-5 to -10%), plant sterols/stanols (-10%), nut consumption (-8%), and soy protein (-3 to -10%) 4.