Cholesterol is made in your liver and has many important functions. For example, it helps keep the walls of your cells flexible and is needed to make several hormones. However, like anything in the body, too much cholesterol creates concerns.

Like fat, cholesterol does not dissolve in water. Instead, to move around the body, it depends on molecules called lipoproteins. These carry cholesterol, fat, and fat-soluble vitamins in your blood.

Different kinds of lipoproteins have different effects on health. For example, high levels of low-density lipoprotein (LDL) result in cholesterol deposits in blood vessel walls, which can lead to:

• clogged arteries

• stroke

• heart attack

• kidney failure

In contrast, high-density lipoprotein (HDL) helps carry cholesterol away from vessel walls and helps prevent these conditions. There are many natural ways to increase HDL (good) cholesterol and lower LDL (bad) cholesterol. While dietary cholesterol may have little influence on your body’s cholesterol levels, other factors in your life may, such as:

• family history

• smoking

• a sedentary lifestyle

• heavy alcohol consumption

Healthy lifestyle choices can help turn the tide by increasing the beneficial HDL and decreasing the harmful LDL. Read on to learn about natural ways to improve your cholesterol levels.

1. Focus on monounsaturated fats

As opposed to saturated fats, unsaturated fats have at least one double chemical bond that changes the way your body uses them. Monounsaturated fats have only one double bond.

Some recommend a low-fat diet for weight loss, but research is mixed on its effectiveness in controlling blood cholesterol.

One research report acknowledged that lower fat intake is an effective way to reduce blood cholesterol levels. However, researchers were concerned about the potential negative effects of low-fat diets, such as lowering HDL (good cholesterol) and increasing triglycerides.

In contrast, research has shown that a diet high in monounsaturated fats, such as the Mediterranean diet, helps reduce levels of harmful LDL and increase levels of healthy HDL.

Monounsaturated fats may also reduce the oxidation of cholesterol, according to research. Oxidized cholesterol can react with free radicals and contribute to clogged arteries. This can lead to atherosclerosis or heart disease.

Overall, monounsaturated fats are healthy because they decrease harmful LDL cholesterol, increase good HDL cholesterol and reduce harmful oxidation.

Here are a few great sources of monounsaturated fats. Some are also good sources of polyunsaturated fat:

• olive oil

• nuts, such as almonds, cashews, pecans, and macadamias

• canola oil

• avocados

• nut butter

• olives

2. Use polyunsaturated fats, especially omega-3s

Polyunsaturated fats have multiple double bonds that make them behave differently in the body than saturated fats. Research shows that polyunsaturated fats reduce LDL (bad) cholesterol and decrease the risk of heart disease.

For example, one study replaced saturated fats in 115 adults’ diets with polyunsaturated fats for 8 weeks. By the end of the study, total and LDL (bad) cholesterol levels were reduced by about 10%.

Polyunsaturated fats also may reduce the risk of metabolic syndrome and type 2 diabetes.

Another study changed the diets of 4,220 adults, replacing 5% of their calories from carbohydrates with polyunsaturated fats. Their blood glucose and fasting insulin levels decreased, indicating a decreased risk of type 2 diabetes.

Omega-3 fatty acids are an especially heart-healthy type of polyunsaturated fat. They’re found in seafood and fish oil supplements. Especially high amounts occur in fatty fish like:

• salmon

• mackerel

• herring

• deep sea tuna like bluefin or albacore

• shellfish (to a lesser degree), including shrimp

Other sources of omega-3s include seeds and tree nuts, but not peanuts.

3. Avoid trans fats

Trans fats are unsaturated fats that have been modified by a process called hydrogenation. This is done to make the unsaturated fats in vegetable oils more stable. The resulting trans fats are not fully saturated and are called partially hydrogenated oils (PHOs).

They are solid at room temperature, which gives more texture than unsaturated liquid oils to products like spreads, pastries, and cookies. Their increased texture, as well as shelf stability, is what makes trans fats so attractive to food companies. But partially hydrogenated trans fats are handled differently in the body than other fats, and not in a good way. Trans fats increase total cholesterol and LDL but decrease beneficial HDL.

The Food and Drug Administration (FDA) banned artificial PHOs, better known as trans fats, in processed foods in the United States as of 2018. The deadline was extended to January 1, 2020, to allow products already produced to work through distribution.

The World Health Organization (WHO) made a global call for the elimination of industrially produced trans fats from the global food supply by 2023.

Foods that commonly contain trans fats include:

• margarine and shortening

• pastries and other baked goods

• some microwaveable popcorn

• fried fast foods

• some pizzas

• nondairy coffee creamer

A study of global health patterns found that consumption of excess trans fats, coupled with insufficient polyunsaturated fats and excess saturated fats, are a significant cause of coronary heart disease mortality globally.

In the United States, and in an increasing number of other countries, food companies are required to list the number of trans fats in their products on nutrition labels. However, these labels can be misleading, because companies are allowed to round down when the amount of trans fat per serving is less than 0.5 grams per serving. This means some foods contain trans fats even though their labels say “0 grams of trans fat per serving.”

To avoid being misled, be sure to read the ingredients list in addition to the nutrition label. If a product contains “partially hydrogenated” oil, it contains trans fats and should be avoided.

4. Eat soluble fibre

Soluble fibre is a group of different compounds in plants that dissolve in water and that humans can’t digest. However, the beneficial bacteria that live in your intestines can digest soluble fibre. In fact, they require it for their own nutrition. Research has shown that these good bacteria, also called probiotics, can help reduce LDL levels.

A research review confirmed earlier findings that whole grains, which contain substantial amounts of fibre, decrease both total cholesterol and LDL cholesterol levels compared with control groups. The good news is that whole grains were not shown to decrease levels of good HDL cholesterol. Soluble fibre can also help increase the cholesterol benefits of taking a statin medication.

One study published in 2014 suggested that, in a group of adults over 45, the use of statins combined with an increase in eating whole grain foods rich in fibre was associated with healthier lipoprotein profiles.

The benefits of soluble fibres stretch to many other diseases. A large review of several studies found high fibre intakes of both soluble and insoluble fibre reduced the risk of death over 17 years by nearly 15%.

Some of the best sources of soluble fibre include:

• oat cereals

• beans and lentils

• Brussels sprouts

• fruits

• peas

• flaxseeds

Fibre supplements like psyllium are also safe and inexpensive sources of soluble fibre.

5. Exercise

Exercise is a win-win for heart health. Not only does it improve physical fitness and help combat obesity, but it also reduces harmful LDL and increases beneficial HDL. The AHA advises that 150 minutes of moderate aerobic exercise a week is enough to lower cholesterol levels.

In one study, 12 weeks of combined aerobic and resistance exercise reduced the especially harmful oxidized LDL in 20 overweight women. They exercised 3 days per week with 15 minutes each of aerobic activity including walking and jumping jacks, resistance-band training and low-intensity Korean dance. While even low-intensity exercise like walking increases HDL, making your exercise longer and more intense increases the benefit.

Ideally, aerobic activity should raise the heart rate to about 75% of its maximum. Resistance training should be 50% of the maximum effort. Activity that elevates the heart rate to 85% of its maximum increases HDL and also decreases LDL. The longer the duration, the greater the effects. Resistance exercise can decrease LDL even at moderate intensity. At maximum effort, it also increases HDL. Increasing the number of sets or repetitions increases the benefit.

Some research disputes the effectiveness of moderate exercise in reducing cholesterol levels. One research review found that low to moderate aerobic exercise did not reduce the levels of LDL, except in several studies limited to specific populations. Another study involving sedentary young women also found no change in lipid profiles after 8 weeks of different types of exercises.

Researchers still recommended moderate exercise, especially for sedentary individuals, as it may help lower some specific-sized LDL particles called subfractions.

6. Maintain a healthy-for-you weight

Having excess weight or obesity can increase your risk of developing high cholesterol levels. Every 10 pounds of excess fat produces roughly 10 mg of cholesterol per day. The good news is that losing weight, if you have excess weight, can decrease your cholesterol levels.

Research shows that people who lost between 5–10% of their weight significantly reduced their total cholesterol and LDL cholesterol levels, as well as triglycerides. Those who lost more than 10% of their weight reduced cholesterol and triglyceride levels significantly more.

One study involving weight loss for women found that a diet high in healthy oils lowered both good and bad cholesterol. Women with overweight or obese engaged in a 1-year behavioural weight loss program and were randomly assigned to 1 of 3 diets:

• low fat and high carbohydrate

• low carbohydrate and high fat

• low carbohydrate and walnut-rich high fat

The walnut-rich diet affected cholesterol levels the most. It decreased LDL and increased HDL. The high-fat, low-carb group, whose diet emphasized monounsaturated fats, did not have the same beneficial cholesterol results as the walnut-rich diet group, whose diet emphasized polyunsaturated fatty acids.

Overall, weight loss has a double benefit on cholesterol by decreasing harmful LDL and increasing beneficial HDL. Work with your doctor closely to determine a nutrient-dense and sustainable weight loss plan.

7. Avoid smoking

Smoking increases the risk of heart disease in several ways. One of these is by changing how the body handles cholesterol.

The immune cells in smokers are unable to return cholesterol from vessel walls to the blood for transport to the liver. This damage is related to tobacco tar, rather than nicotine. These dysfunctional immune cells may contribute to the faster development of clogged arteries in smokers.

Cigarettes contain a toxic chemical compound called acrolein that can be absorbed into the bloodstream through the lungs. Scientists believe it impairs how HDL in the body transports cholesterol and thereby increases LDL levels, which may lead to the development of heart disease).

Giving up smoking, if possible, can help reverse these harmful effects.

8. Use alcohol in moderation

Alcohol’s role in providing heart-protective benefits is one of today’s major health debates. Some research indicates that when used in moderation, alcoholic drinks can increase good HDL cholesterol and reduce the risk of heart disease.

Both the Centers for Disease Control and Prevention (CDC) and the AHA disagree. The AHA does not endorse drinking wine or any other alcoholic beverage specifically to lower your cholesterol or improve your heart health. Both organizations say there is no credible research linking alcohol and improved heart health. The AHA acknowledges there may be a small rise in good HDL cholesterol with moderate alcohol use, but it says exercise is a better way to achieve this benefit.

Some research recommends that alcohol consumption recommendations be reconsidered in light of its harmful effects on cardiovascular health, even in lower amounts. What especially worries researchers about recommending moderate use of alcohol is the slippery slope down to misuse.

The AHA points out that triglycerides and total cholesterol levels increase with heavy alcohol intake. A recent study shows that heart damage may be occurring with heavy alcohol use even before symptoms appear. Although the question remains about whether or not alcohol can reduce heart disease risk, everyone agrees that too much alcohol harms the liver and increases the risk of dependence. It is important to consume alcohol only in moderation to achieve any potential cardiovascular benefit.

The CDC suggests you moderate drinking by consuming only 2 drinks per day for men or 1 drink per day for women, on days that you drink.

9. Consider plant sterols and stanols

Multiple types of supplements show promise for managing cholesterol. Plant stanols and sterols are plant versions of cholesterol. Because they resemble cholesterol, they are absorbed from the diet like cholesterol.

However, because parts of their chemistry are different from human cholesterol, they do not contribute to clogged arteries. Instead, they reduce cholesterol levels by competing with human cholesterol. When plant sterols are absorbed from the diet, this replaces the absorption of cholesterol. Small amounts of plant stanols and sterols are naturally found in vegetable oils and are added to certain oils and butter substitutes.

A research review reported that clinical studies show that taking 1.5–3 grams of plant sterols/stanols daily can reduce LDL concentration by 7.5–12%. Researchers said taking it with a main meal twice per day allows for optimal cholesterol-lowering.

Although research has established the cholesterol-lowering benefit of plant stanols and sterols, it has not yet proved that they decrease the risk of heart disease. Numerous clinical trials have suggested that plant sterols supplements and enriched foods may lower heart disease risk, but hard data is still lacking.

10. Try supplements

There is strong evidence that fish oil and soluble fibre improve cholesterol and promote heart health. Another supplement, coenzyme Q10, is showing promise in improving cholesterol, although its long-term benefits are not yet known.

Fish oil

Fish oil is rich in the omega-3 fatty acids docosahexaenoic acid (DHA) and eicosapentaenoic acid (EPA).

One study found that supplementing the diets of older adults who had high blood pressure and high cholesterol with fish oil-based Omega3Q10 reduced high blood pressure and both total cholesterol and LDL levels.

However, the AHA surprised the medical world in 2020 with the announcement that its international STRENGTH trial involving a medication made from fish oil failed to reduce the risk of cardiac events. The study involved 13,000 people who either had existing heart disease or were at risk of developing it.

Researchers acknowledged that while many people take fish oil to reduce the risk of developing heart disease, at least with the product they used, this connection did not hold true. Researchers called for another trial to be conducted to resolve the issue.

Psyllium

Psyllium is a form of soluble fibre available as a supplement. A research review of 28 studies found that psyllium fibre effectively lowers LDL cholesterol levels, potentially delaying the cardiovascular disease risk caused by clogged arteries in those with or without high cholesterol.

The FDA agrees, saying 7 grams of soluble fibre per day, taken from 10.2 grams of psyllium husk, helps reduce the risk of coronary artery disease based on psyllium’s ability to reduce cholesterol levels.

Coenzyme Q10

Coenzyme Q10 is a food chemical that helps cells produce energy. It is similar to a vitamin, except that the body can produce its own Q10, preventing deficiency. Even if there is no deficiency, extra Q10 in the form of supplements may have benefits in some situations.

Several studies with a total of 409 participants found coenzyme Q10 supplements reduced total cholesterol. In these studies, LDL and HDL did not change. A research review involving people with coronary artery disease showed that CoQ10 supplementation improved their lipid profiles by decreasing total cholesterol and increasing HDL levels. Triglycerides and LDL levels remained unaffected.

Another research review examines the effect of Q10 in treating cardiovascular and metabolic diseases. It found many encouraging results on the supplementation of COQ10 in different conditions but concluded that data was controversial and limited and that more research is needed.

In conclusion

Cholesterol has important functions in the body but can cause clogged arteries and heart disease when it gets out of control. LDL is prone to free radical damage and contributes most to heart disease. In contrast, HDL protects against heart disease by carrying cholesterol away from vessel walls and back to the liver.

If your cholesterol is out of balance, lifestyle interventions are the first line of treatment. Unsaturated fats, soluble fibre, plant sterols and stanols can increase good HDL and decrease bad LDL. Exercise and weight loss can also help. Eating trans fats and smoking is harmful and should be avoided.

The CDC recommends that you have your cholesterol levels checked every 5 years starting at age 20. Ask your doctor about any concerns you have. A simple blood draw, taken after an overnight fast, is all that’s required.

Disclaimer: This article has been developed for educational purposes only. It is not a substitute for professional medical advice. Should you have questions or concerns about any topic described here, please consult your medical professional.