Cholesterol is a waxy, fat-like substance found in the blood and every cell of the body. Total cholesterol has three main constituents: low-density lipoprotein (LDL), also known as “bad” cholesterol; high-density lipoprotein (HDL), also known as “good” cholesterol; and triglycerides, a certain type of fat. Some amount of cholesterol is needed to keep the cells and organs healthy. Alternatively, high levels of LDL or bad cholesterol in the body cause the accumulation of fats in the blood vessels. This plaque may lead to heart attack, stroke, or other health issues.

According to a study conducted by the National Heart, Lung, and Blood Institute (NHLBI), unhealthy lifestyle choices can cause high levels of bad cholesterol in the body.  Additionally, one’s inherited genes, medical conditions like chronic kidney disease, diabetes, obesity, PCOS, menopause, etc., and certain medications may also contribute to high cholesterol. Our previous post discussed these factors contributing to high cholesterol. This post will discuss how to lower your cholesterol. 

One could lower the unhealthy blood cholesterol levels by making some lifestyle changes. People with a family history of high cholesterol usually require additional medication or a special procedure,  in addition to lifestyle changes.

The following are some natural ways to lower cholesterol levels. 

Shifting to heart-healthier food choices: High cholesterol boosts your risk of heart disease and heart attacks. No doubt medications can help improve your cholesterol. However, it is recommended to first try changing your diet. You can do so by:

• Reducing intake of saturated and trans fats. Previous research has shown strong evidence that decreasing your consumption of saturated and trans fats can reduce the levels of “bad” cholesterol in the body (1). Saturated fats are usually found in meats like beef, poultry with skin, or lamb and dairy products. Trans-fat could also be found in packaged snacks or desserts.  According to one study, one must not consume more than 25–35 percent of daily calories from total fat (sum of saturated, trans, monounsaturated, and polyunsaturated fat), out of which saturated fat should not be more than 7 percent. One should eat more fresh fruits and green leafy vegetables to cut down on saturated fat (1).
• Eating food rich in Omega-3 fatty acids. The US Department of Health and Human Services’ report on  Dietary Guidelines for Americans suggested that one should eat food that is rich in omega-3 fatty acids and does not affect LDL cholesterol. Examples include salmon, mackerel, herring, walnuts, and flaxseeds.
• Eating a diet rich in soluble fiber. It is recommended to increase the intake of soluble fiber. It is essential for good health as it reduces the absorption rate of cholesterol in the blood. A diet rich in soluble fiber is good for digestion and can also help to reduce your risk of heart disease. Good sources of soluble fiber include oats, kidney beans, brussels sprouts, avocados, flax seeds, apples, and pears.
• Reading the food labels properly. Food labels may act as your best guide to help you find heart-healthy products. One should always check the nutrition facts label on the food package. It provides you with detailed information related to the nutritional value and number of servings in the food item.

Engage in physical activities. Engaging in regular physical activity has many benefits. Research has revealed that physical activity can help lower “bad” LDL cholesterol and triglycerides and increase your “good” HDL cholesterol. Therefore, engaging in some sort of physical activity like walking, biking, swimming, jogging, or using an exercise machine at low speed, is recommended. Those who are new to the exercise regime are advised to take some precautions. Here are few tips: 

• Warm-up and cool down by spending about five minutes on each before and after the exercise.
• Start slowly with your working out regime. It may be as little as 10 to 20 minutes on a daily basis, which you can increase at your own pace. 
• Set a workout goal. For example, you may have set 200 minutes per week of moderate exercise. All it takes is about 28 minutes of exercise seven days per week. 
• Choosing the right exercise. People often wonder which will yield the best results. The answer is “the one you will do regularly and dedicatedly.” Find an exercise you enjoy and stick with it. Please be sure to check with your doctor before starting any exercise program. 

Exercise alone won’t have much impact on LDL cholesterol unless combined lifestyle changes including variations in dietary patterns and weight loss. 

Smoking and chewing tobacco are the major contributors to raising triglyceride levels in the blood. Quitting smoking and chewing tobacco at any stage would always benefit you. 

Limit the alcohol intake:  According to the American Addiction Centers, regular heavy alcohol intake, which includes wine, beer, hard liquor, or mixed drinks, is associated with higher levels of bad cholesterol (LDLs) and high blood pressure. Additionally, the continuous and prolonged use of alcohol can lead to chronic high cholesterol and can cause damage to the pancreas. Other research revealed that moderate to mild amounts (no more than one 5-ounce serving per day of red wine) are associated with healthy cholesterol levels (3). The key here is to avoid consuming heavily, on a regular basis, to keep your heart healthy.

Get enough sleep:  This is one of the toughest things to do in this fast-paced world. However, getting enough quality sleep is required for good health. When you are sleeping, your body is working to maintain a healthy hormone balance that makes you feel hungry or full. Additionally, proper sleep heals and repairs your heart and blood vessels and decreases your risk for chronic health problems. It also plays an important role in maintaining a healthy immune system. According to the National Heart, Lung, and Blood Institute, the American Academy of Sleep Medicine (AASM) recommends certain hours of sleep required for various ages.

Table 1: Recommended hours of sleep in a day for various ages
Age	Recommended hours of sleep in a day
Babies 4-12 months	12-16 (including naps)
Children 1-2 years	11-14 (including naps)
Children 3-5 years	10-13 (including naps)
Children 6-12 years	9-12
Teens 13-18 years	8-10
Adults 18 years or older	7-9

Stress and Cholesterol:  Stress, a feeling of emotional or physical tension, can lead to many health problems, including high blood pressure, heart attack, and other heart disease risk factors.  The research revealed that people who experience more stress at work increase their chances of being diagnosed with high cholesterol (3). Therefore, one should practice stress management strategies to improve mental and physical health. Some strategies include:

• Meditation;
• Discussing symptoms with a professional counselor;
• Engaging in various types of physical activities;
• Practicing relaxation techniques like breathing exercises, self-hypnosis, etc.;
• Maintaining social support by talking with close friends, family members, and members of the community, etc.

Written by Dr. Shikha Sharma, Reviewed by Dr. Harshi Dhingra