What are the dietary and exercise management strategies for elevated Low-Density Lipoprotein (LDL) cholesterol?

From the Guidelines

Managing elevated LDL cholesterol through diet and exercise requires a comprehensive approach focused on heart-healthy eating patterns and regular physical activity, as recommended by the most recent and highest quality study 1. To lower LDL cholesterol, adopt a diet low in saturated fats (found in red meat and full-fat dairy) and trans fats (in processed foods), while increasing consumption of soluble fiber from foods like oatmeal, beans, and fruits. Some key points to consider:

• Aim for 25-30 grams of fiber daily, as suggested by 1.
• Include plant sterols and stanols found in fortified foods, along with omega-3 fatty acids from fatty fish like salmon (twice weekly), flaxseeds, and walnuts.
• For exercise, engage in at least 150 minutes of moderate-intensity aerobic activity weekly, such as brisk walking, swimming, or cycling, combined with muscle-strengthening activities twice weekly, as recommended by 1 and 1.
• Even modest weight loss of 5-10% can significantly improve cholesterol levels, as noted in 1 and 1. These lifestyle changes work by reducing the production of LDL cholesterol in the liver, enhancing its clearance from the bloodstream, and improving overall metabolic health. For optimal results, these changes should be maintained consistently, with cholesterol levels rechecked after 3-6 months to assess effectiveness before considering medication if targets aren't reached, as suggested by 1 and 1.

From the Research

Elevated LDL Cholesterol Management with Diet and Exercise

Elevated LDL cholesterol can be managed through a combination of diet and exercise. The following are some key points to consider:

• Dietary modifications are a primary focus of therapeutic lifestyle change (TLC) therapy for patients with dyslipidemias, as recommended by the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) cholesterol guidelines 2
• Saturated fat intake should be limited to less than 7% of total caloric intake, and trans-fatty acid intake should be low for patients with dyslipidemias 2
• Increasing physical activity has extensive benefits, including improving both blood pressure and blood cholesterol, and is a critical component of first-line treatment for elevated blood pressure or cholesterol 3
• A diet high in saturated fatty acids (SFA) is a suspected contributor to atherosclerotic cardiovascular disease (ASCVD) risk, and most dietary guidance from health authorities advocates limiting intake of SFA, particularly for people with clinical ASCVD, dyslipidemia, or diabetes mellitus 4
• Replacing SFA with unsaturated fatty acids, particularly polyunsaturated fatty acids, may reduce ASCVD risk 4

Key Dietary Recommendations

Some key dietary recommendations for managing elevated LDL cholesterol include:

• Minimizing saturated fats and refined carbohydrates 5
• Eliminating trans-fat 5
• Increasing fruits, vegetables, whole grains, low-fat dairy, and fish or other omega-3 fatty acids 5
• Adhering to a Mediterranean diet, which has been shown to lower cardiovascular disease and total mortality 5
• Limiting SFA intake to <10% of total daily energy for the general healthy population, and further (e.g., to 5-6% of total daily energy) for patients with hypercholesterolemia 4

Exercise and Physical Activity

Regular exercise and physical activity are also important for managing elevated LDL cholesterol, and can help to:

• Improve blood pressure and blood cholesterol 3
• Reduce the risk of cardiovascular disease 3
• Increase high-density lipoprotein (HDL) cholesterol, which can help to remove excess cholesterol from the bloodstream 6