The Rationale for Choosing Natural Ways to Lower Cholesterol Over Prescription Drugs
Cholesterol is perhaps the most misunderstood nutrient of all. To many of us, it functions essentially as a bogeyman, hence the plethora of articles out there promising to provide you with the most effective natural ways to lower cholesterol.
It's understandable how it got cast in that role. After all, the statistics can be overwhelming. For instance, the Centers for Disease Control and Prevention (CDC) lists the following alarming facts about cholesterol:
- High blood cholesterol significantly increases your risk of heart disease, the leading cause of death in America.
- 71 million American adults—or 33.5% of the population—have high levels of low-density lipoprotein (LDL, colloquially known as the “bad” kind of cholesterol).
- Only 1 out of every 3 adults with high LDL cholesterol has that serious health condition under control.
- Because high cholesterol itself, separate from the chronic diseases it can instigate, has no symptoms, many people are unaware that their cholesterol levels are too high.
- By lowering your cholesterol levels, you can reduce your risk of facing serious consequences stemming from heart disease, such as suffering a heart attack, undergoing heart bypass surgery or angioplasty, or even dying from heart disease.
After reviewing those sobering facts, you may be wishing you could magically remove all the cholesterol from your body. If you could achieve that, however, you would soon regret it. Cholesterol actually carries out a number of vital functions inside the body, such as helping to keep the walls of your cells flexible and facilitating the production of several hormones.
Before diving into my recommendations on truly useful strategies for optimizing your cholesterol levels, let's get clear on what cholesterol is, how it works in the body, and the connection between dietary cholesterol and blood cholesterol.
What Is Cholesterol?
Cholesterol, in the simplest terms, is a waxy, fatty substance made by the liver. As touched on above, your body needs some cholesterol for certain key functions. When it begins to accumulate, however, it can cause problems.
Cholesterol belongs to a category of particles called blood lipids. In fact, cholesterol is the best-known blood lipid. While the term "blood lipids" technically refers to fat particles circulating in the bloodstream, it's conventionally used to refer to particles in the blood that are combinations of lipids and protein, like cholesterol.
The Basics of High-Density Lipoprotein, Low-Density Lipoprotein, and Very Low-Density Lipoprotein
Because cholesterol is a combination of lipid and protein, cholesterol-containing particles in the blood are called lipoproteins. These include high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoproteins (VLDL). The other primary type of fat in the blood are triglycerides, so named because they form when three fatty acid molecules hook together.
Each type of lipoprotein affects your health in different ways. Excess quantities of low-density lipoprotein, for example, can build up on the walls of your blood vessels, resulting in clogged arteries, strokes, heart attacks, and even kidney failure. High-density lipoprotein, however, actually clears away cholesterol deposits from blood vessel walls, thereby lowering your risk of the same set of adverse health outcomes.
So, when we talk about finding ways to lower cholesterol, the precise target of those strategies is low-density lipoprotein, not high-density lipoprotein.
The liver is the main site of fatty acid and cholesterol production. Fatty acids produced in the liver link together to form triglycerides. While triglycerides and cholesterol are made in the liver, the liver is not equipped to store much of either. Consequently, they are packaged with proteins and secreted into the blood as very-low-density lipoproteins (VLDL).
VLDL molecules serve as the primary transporters of fat from the liver to the peripheral fat stores. As VLDL circulates in the blood, it deposits fatty acids and cholesterol in your adipose tissue—otherwise known as body fat.
I should briefly note here that not all the triglycerides produced by the liver are excreted as VLDL—some can be secreted in the form of triglycerides directly into the blood. This is another way that fatty acids are transferred from the liver to adipose tissue for storage.
Adipose tissue is the proper storage site for triglycerides. A larger amount of fat can be stored in adipose tissue. Under normal conditions, fat can be stored in adipose tissue without any adverse impact on overall health, though an excessive amount of triglyceride storage factors into obesity.
The triglycerides in the VLDL molecules are taken up by the adipose tissue thanks to a protein called lipoprotein lipase. This enzyme is not completely effective, though, resulting in incomplete clearance of the VLDL by the adipose tissue. The fat that remains in the blood becomes low-density lipoproteins (LDL), which circulate back to the liver where they are either cleared from the blood or taken up by other cells in the body. This is the main route by which cholesterol is delivered to the tissues of the body.
A special receptor on the membranes of the liver and other tissues plays a key role in taking up the cholesterol from LDL molecules. If the cholesterol in LDL is taken up by the liver, it is then metabolized and eliminated from the body. Conversely, cholesterol taken up by other tissues can remain and disrupt normal bodily functions.
I previously mentioned that low-density lipoprotein has earned itself the infamous nickname "bad" cholesterol. As you may already know, or be able to intuit, that makes high-density lipoprotein (HDL) the “good”cholesterol, in large part because it clears LDL from the blood.
HDL cholesterol, also released by the liver, carries unabsorbed, un-utilized cholesterol back to the liver in a process called reverse cholesterol transport. This keeps your arteries free from cholesterol accumulation, which in turn reduces your risk of heart disease and stroke.
The more HDL in your bloodstream relative to LDL, the more rapidly cholesterol will be cleared by the liver, broken down, and excreted. When evaluating your cholesterol levels, doctors commonly test for and give serious weight to your LDL:HDL ratio.
The Role of Cholesterol in the Body
During a physical exam, it is routine to have the concentrations of these blood lipids measured, and if the values are out of the normal range, treatment options are recommended. This gives us the very distinct feeling that the blood lipids are all bad.
Normal values for blood lipids are as follows:
- LDL < 100 mg/dl
- HDL ≥ 40 mg/dl
- Triglycerides < 150 mg/ml
While elevated levels of some of the blood lipids are indeed associated with bad health outcomes, let’s first consider some of the beneficial roles of blood lipids.
Cholesterol plays many roles in the body, including helping the body produce certain hormones, vitamin D, and enzymes that help you digest food. Cell membranes are largely made up of lipids. Problems arise, however, when you have high cholesterol levels, high triglyceride levels, or both. Excess is never a good thing.
How Excess Cholesterol Harms Your Health
LDL, as previously touched on, has the reputation of being the worst of the blood lipids. The cholesterol in LDL can accumulate and form plaques that stiffen your arteries. This condition is called atherosclerosis.
Cholesterol-rich plaques can clog the arteries, leaving less room for blood to circulate. Plaques can also rupture, which causes platelets to come to the site of rupture and form blood clots. If the clot is big enough, it can block blood flow. If this happens in a vessel supplying blood to the heart, it will cause a heart attack, and if it happens in a vessel supplying blood to the brain, it will cause a stroke.
Triglycerides are also a risk factor for atherosclerosis and, therefore, heart attack and stroke. Recently physicians have been paying even more attention to an elevated triglyceride level because that is one of the underlying factors that leads to metabolic syndrome. Triglyceride accumulation in the liver, specifically, has been shown to drive the progression of metabolic syndrome, which is itself a precursor to diabetes. This means the diagnosis and treatment of metabolic syndrome is critical to diabetes prevention.
Conventional Strategies to Lower LDL Cholesterol and Triglyceride Levels
A class of drug called statins are widely prescribed to lower LDL cholesterol levels. While statins are usually effective in doing so, they come with side effects—most commonly, muscle pain. The side effects of statins can be particularly pronounced in older individuals. In some cases, that muscle pain can be alleviated by switching to a different type of statin, or by taking a dietary supplement called Coenzyme Q10, or CoQ10. One of the side effects of statins is CoQ10 depletion, and given that CoQ10 contributes to the body's energy production system, it can be quite worthwhile to reestablish healthy levels.
There are other medications to help lower LDL levels, including cholesterol absorption inhibitors, fibrates, and niacin. Again, all these drugs commonly come with adverse side effects. The cholesterol absorption inhibitors that block fat absorption can lead to diarrhea, fibrates can impair normal liver function (again, especially in older individuals), and niacin can cause itching and flushing.
Keep in mind that while these medications may help lower cholesterol, they usually do not affect triglyceride levels. Fibrates are the most effective prescription medication to lower triglycerides, but adverse effects on the liver limit the use of these drugs.
Plus, of those medications, only fibrates have been shown to effectively lower triglycerides, and their adverse effects on the liver limit their use.
Thus, though there are several prescription drug options shown to effectively lower LDL cholesterol levels, most do not address high levels of triglycerides. That, in combination with the numerous potential side effects associated with those medications, inspires many to seek out more natural ways to lower cholesterol.
The Link Between Your Diet and Lifestyle Choices and Your Blood Cholesterol Levels
The cholesterol myth is still holding strong: that you can lower cholesterol by cutting out cholesterol in the diet. This is a fallacy. Cholesterol in the blood is produced in the liver, not absorbed from digested food.
Though food manufacturers continue to shill low-cholesterol products, the truth is that dietary cholesterol has a fairly small impact on the amount of cholesterol circulating in the body. One reason for that is your liver's ability to modulate how much cholesterol it produces in response to how much cholesterol your diet contains. If you're taking in more cholesterol from the foods you eat, your liver scales back cholesterol production accordingly.
Take eggs, for example, which have long been scapegoated as unhealthily high in cholesterol. According to a study published in the European Journal of Nutrition, study participants randomly assigned to increase their dietary cholesterol intake by adding two eggs to their daily diet did not experience increases to their total cholesterol or lipoprotein levels compared to participants following diets with fewer high-cholesterol foods.
No wonder then that the most recent dietary guidelines from the U.S. Department of Agriculture give the green light to eating eggs, cholesterol-rich yolks and all. Feel free to enjoy whole-egg omelettes, with no side of guilt needed.
Although dietary cholesterol does not substantially influence your cholesterol levels, other foods in your diet do affect them—both for the good and the bad. Certain behaviors, such as smoking or the amount of physical activity you get, can also have an influence.
Read on to learn about the lifestyle changes that can increase your good HDL cholesterol levels while lowering your bad LDL cholesterol and triglyceride levels.
10 Natural Ways to Lower LDL Cholesterol and Triglyceride Levels
Certain dietary and lifestyle behaviors are associated with lowering cholesterol, but it should be noted that some of these are merely associations, and association does not prove cause and effect. Studies showing a significant effect of certain changes in diet or behavior may be occurring at the same time as other changes that are actually responsible for the observed response. So, let’s stick to approaches that have a physiological rational, if not a scientifically proven mechanism of action.
1. Up Your Physical Activity
When it comes to improving your heart health, few lifestyle changes can be as impactful as increasing your physical activity. Strong evidence shows that exercise can optimize cholesterol levels, both by decreasing damaging LDL cholesterol as well as increasing healthful HDL cholesterol.
According to one 12-week study, a program that combined aerobic and resistance exercise successfully reduced LDL cholesterol. Participants spent 3 days weekly engaging in a variety of aerobic activities, including walking, jumping jacks, resistance-band training, and Korean dance.
Research indicates that exercise can increase HDL cholesterol too. A review of multiple published investigations indicate that both aerobic exercise and resistance training of varying volumes and intensities can beneficially impact all different types of cholesterol.
The review found that 30 minutes of exercise carried out 5 days a week can optimize cholesterol levels and lower your risk of heart disease.
The authors found that the ideal threshold for aerobic activity is to raise the heart rate to approximately 75% of its maximum. When your heart rate reaches 85% of its maximum, you both increase your HDL and decrease your LDL.
For resistance training, you should strive to hit at least 50% of your maximum exertion, though even a lower intensity effort can decrease LDL. As your exertion level increases, you begin positively impacting your HDL. By increasing the number of sets and repetitions you carry out, you maximize the benefits you experience.
2. Consider Weight Loss
Solid evidence shows that losing weight can decrease the amount of cholesterol your liver generates.
A study published in the American Journal of Clinical Nutrition showed that one mechanism by which weight loss decreases cholesterol production is by increasing the absorption of cholesterol from the food participants ate. Over the course of the study, participants levels of HDL cholesterol increased and participants' risk of heart disease dropped.
A similar study conducted by the American Heart Association that looked specifically at the use of a diet found that weight loss can also decrease LDL cholesterol levels, which may have an even more direct effect on heart health.
3. Increase Monounsaturated Fat Intake
From a certain angle, it might seem logical to reduce overall fat intake in order to support the dual goals of losing weight and optimizing cholesterol levels. However, at least one study found that when participants followed a low-fat diet, HDL levels dropped along with LDL levels.
By contrast, it appears that adhering to a diet high in monounsaturated fat can cut LDL levels while leaving HDL levels intact or even increasing them. One study compared the effect of a diet high in monounsaturated fat to that of a diet low in saturated fat, and found that the diet that prioritized monounsaturated fat increased HDL levels by 12%.
As opposed to saturated fats, unsaturated fats have at least one double chemical bond that changes the way they are used in the body. Monounsaturated fats have only one double bond.
Valuable dietary sources of monounsaturated fats include:
- Olives and olive oil
- Avocados and avocado oil
- Tree nuts including almonds, walnuts, pecans, hazelnuts, and cashews
- Cooking oils made from plants, such as sesame and sunflower oil
4. Avoid Trans Fats
In order to make unsaturated fats more stable, which then increases the shelf life of products that contain them, manufacturers use a process known as hydrogenation.
This results in fats that are not fully saturated, but remain solid at room temperature. It's common to find trans fats in products such as spreads, pastries, and cookies, since they result in a more desirable texture than unsaturated, liquid oils do.
The effects these partially hydrogenated trans fats have on the human body, however, are far from desirable. Not only do they increase total cholesterol and LDL cholesterol, but they also decrease HDL cholesterol—in some cases, by up to 20%.
One study estimated that trans fat intake may account for 8% of heart disease deaths worldwide, while another predicted that by restricting the use of trans fats, heart disease deaths could be reduced by 4.5%.
While food companies are required to disclose the presence of trans fats in their products, they are allowed to round down when the amount of trans fat per serving is under 0.5 grams. As a result, some foods feature labels proclaiming that they contain 0 grams of trans fat per serving when, in fact, they do contain trans fats.
Outsmart manufacturers by reading the ingredients list in addition to the nutrition facts. If you see partially hydrogenated oil, or a similar phrase, the product in question contains trans fats and should be avoided.
5. Boost Omega-3 Fatty Acid Intake
Omega-3 fatty acids are a particularly heart-healthy, cholesterol-lowering kind of polyunsaturated fat.
Research shows that due to their multiple double bonds, polyunsaturated fats function differently inside the body than saturated fats do. It appears they can lower levels of LDL cholesterol, consequently lowering your risk of heart disease too.
Multiple studies indicate that prioritizing your intake of polyunsaturated fats while cutting back on saturated fats can decrease your LDL and total cholesterol levels. This benefits your overall health by reducing your risk of coronary artery disease, metabolic syndrome, and type 2 diabetes.
Good sources of omega-3 fatty acids include:
- Fatty fish such as salmon, sardines, herring, and bluefin or albacore tuna
- Scallops and mussels
- Seeds and tree nuts
6. Eat More Soluble Fiber
Humans can't digest soluble fiber, yet it's still important to include it in our diets. The probiotics that live in our intestines thrive off soluble fiber, and these industrious little bacteria can clear out both LDL and VLDL cholesterol from the bloodstream.
Studies have primarily focused on the use of soluble fiber supplements as well as foods fortified with added soluble fiber. According to one, taking 3 grams of soluble fiber each day over the course of 12 weeks led to an 18% drop in LDL cholesterol levels.
When researchers looked more generally at the health benefits of fiber, they linked an increased intake of fiber-rich grains and cereals to a longer lifespan. One study that surveyed over 350,000 adults found that those eating the most fiber were between 15% and 20% less likely to die during the course of the 14-year study.
Key sources of soluble fiber include:
- Beans, peas, and lentils
- Apricots, nectarines, and pears
- Oats and whole grains
- Psyllium supplements
7. Stop Smoking
As you are likely aware, one of the many negative ways smoking impacts your health is by elevating your risk of heart disease.
One reason for this is that smoking changes the way the body metabolizes cholesterol. Tobacco tar damages the immune cells, rendering them unable to remove cholesterol from blood vessel walls so it can be transported back to the liver. Experts believe that, due to these dysfunctional immune cells, smokers develop clogged arteries faster than non-smokers do.
The good news is, the damage appears to be reversible. Smoking cessation, with or without the use of transdermal nicotine patches, can undo the harmful effects of tobacco tar and return immune cells to full, cholesterol-removing capacity.
8. Drink Alcohol Moderately
As is true of cholesterol itself, the right amount of alcohol can improve your health, but if the balance skews too far, the effects can be quite detrimental.
Thanks to the ethanol it contains, alcoholic drinks can raise your HDL cholesterol levels, which as I have stated previously, lowers your risk of heart disease.
One study compared the effects of 24 grams of white wine to an equal quantity of white grape juice. The wine improved HDL levels by 5%.
Separate findings indicate that alcohol can also beneficially impact reverse cholesterol transport, which decreases the likelihood of clogged arteries as well as heart disease. The standard recommendation is no more than two drinks per day for men and one drink per day for women.
9. Add Plant Sterols and Stanols to Your Diet
Plant stanols and sterols are, in essence, the plant versions of cholesterol. They resemble the cholesterol produced by human livers, but because of certain differences in their chemistry, they do not accumulate on the walls of blood vessels.
In fact, they actually lower total cholesterol levels. When the body absorbs plant sterols, they replace the absorption of human cholesterol.
While research indicates plant sterols and stanols can lower LDL cholesterol levels—by between 15% and 20%—it remains to be seen whether those benefits lower a person's risk of heart disease.
Some of the top sources of plant stanols and sterols include:
- Wheat germ and wheat bran
- Brussels sprouts
10. Try Science-Backed Supplements
Both fish oil and psyllium fiber have been shown to optimize cholesterol levels and enhance heart health, while CoQ10 shows clear promise in its effect on cholesterol levels though its long-term benefits have yet to be fully mapped.
Last but certainly not least, exciting new findings reveal that consuming essential amino acids in the form of a nutritional supplement can lower liver and blood triglycerides as well as total cholesterol, LDL cholesterol, and VLDL cholesterol, whether taken alone or with plant stanols and sterols.
Given the focus on fish in the section on omega-3 fatty acids, the source of fish oil's influence on cholesterol levels should come as no surprise: the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).
Researchers have found that taking fish oil can decrease the total amount of cholesterol present in the blood, increase HDL cholesterol levels, reduce your risk of heart disease, and prolong your overall life expectancy.
There's no question that the supplemental form of soluble fiber can reduce both total cholesterol and LDL cholesterol.
Studies show that the daily use of a psyllium fiber supplement can lower cholesterol levels by between 5% and 10%.
As touched on previously, coenzyme Q10, or CoQ10, assists with the cellular production of energy. Though the body can produce its own CoQ10, deficiencies can arise. And even in the absence of a deficiency, it can be beneficial to supplement with CoQ10.
Multiple studies show that taking a CoQ10 supplement can reduce total cholesterol levels. Plus, it seems increasing your CoQ10 intake can help treat heart failure.
Essential Amino Acids
Essential amino acids (EAAs) are the only required dietary macronutrient. They are involved as key components of all proteins in the body and play various physiological roles. EAAs are in all forms of dietary protein, so regardless of the nature of your diet, you consume at least some EAAs.
EAAs stimulate the synthesis of proteins involved in transporting lipids from the liver to peripheral fat, as well as the protein required for the clearance of fatty acids into adipose tissue for storage. Dose response studies have not been done, but successful reduction of blood and liver lipids was achieved with two doses of 11 grams of EAAs twice per day.
The great advantage of EAA supplements is that they are natural, and essential, components of our regular diet and pose no known risks of adverse responses. Not only can they impart beneficial effects by themselves on blood and liver lipids, but they can also boost the effectiveness of statins. In addition to the positive influence EAAs have on blood lipids, they also have proven benefits for muscle health and physical function. You can get these benefits from Life, The Amino Company's Active Aging blend of EAAs. Click here to learn more.