First, a quick explainer: Cholesterol is a waxy substance that travels through your bloodstream, but not all of it is bad. HDL cholesterol (a.k.a. "good" cholesterol) actually sweeps away LDL cholesterol, or the "bad" kind. A high LDL level puts you at risk for heart attacks and strokes because it can clog arteries with plaque, a condition called atherosclerosis. A blood test can determine whether you have high cholesterol, and your doctor may recommend exercise or medication in addition to a healthier diet.

When your body has too much LDL cholesterol, the LDL cholesterol can build up on the walls of your blood vessels. This buildup is called “plaque.” As your blood vessels build up plaque over time, the insides of the vessels narrow. This narrowing blocks blood flow to and from your heart and other organs. When blood flow to the heart is blocked, it can cause angina (chest pain) or a heart attack.
While diet and exercise should be your two main options for fighting off LDL cholesterol, you can also look into the various dietary supplements that are on the market today. Consider omega-3 fish oils, artichoke extract, and green tea extract. Keep in mind that these natural products have not been fully proven to reduce your level of LDL cholesterol, but they may be able to help along the way.
The lipid profile blood test reports the levels of cholesterol and triglycerides in the bloodstream. Healthcare organizations have established a set range for total, bad LDL and good HDL cholesterol as well as triglycerides, but the most important thing to consider when looking for how to lower cholesterol naturally is the ratio of LDL to HDL cholesterol, which should be around 2:1. (1, 2)

Plasma HDL is a small, spherical, dense lipid-protein complex that is half lipid and half protein. The lipid component consists of phospholipids, free cholesterol, cholesteryl esters, and triglycerides. The protein component includes apo A-I (molecular weight, 28,000) and apo A-II (molecular weight, 17,000). Other minor, but important, proteins are apo E and apo C, including apo C-I, apo C-II, and apo C-III.
HDL serves as a chemical shuttle that transports excess cholesterol from peripheral tissues to the liver. This pathway is called the RCT system. In this system, plasma HDL takes up cholesterol from the peripheral tissues, such as fibroblasts and macrophages. (A study by El Khoury et al indicated that in persons with HALP, macrophages have an increased plasma cholesterol efflux capacity. [18] ) This may occur by passive diffusion or may be mediated by the adenosine triphosphate (ATP)–binding cassette transporter 1. The latter interacts directly with free apo A-I, generating nascent, or so-called discoidal, HDL. Cholesterol undergoes esterification by lecithin-cholesterol acyltransferase (LCAT) to produce cholesteryl ester, which results in the production of the mature spherical HDL. Cholesterol is also taken up from triglyceride-rich lipoproteins in a process mediated by a phospholipid transfer protein (ie, CETP). [19, 20, 21, 22]
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If you skip breakfast, you might want to give the most important meal of the day another shot. Women who eat a bowl of fiber-rich cereal every morning have lower levels of cholesterol than those who don't eat breakfast at all. It's all thanks to the fiber: "Fiber binds with cholesterol and speeds its excretion before it reaches your arteries," says Tanya Zuckerbrot, RD.
According to the Mayo Clinic, ideal HDL levels for both men and women are 60 milligrams of cholesterol per deciliter of blood. If a man’s HDL level is below 40 milligrams of cholesterol per deciliter of blood or a woman’s HDL level is below 50 milligrams of cholesterol per deciliter of blood, then disease risk, specifically heart disease, is considered to be heightened. Even if your HDL level is above the at-risk number (but below the desirable number), you still want to work on increasing your HDL level so you can decrease your heart disease risk. (9)
Research shows that there isn't really a link between how much fat you eat and your risk of disease. The biggest influence on your risk is the type of fat you eat. Two unhealthy fats, including saturated and trans fats, increase the amount of cholesterol in your blood cholesterol and increase your risk of developing heart disease. However, two very different types of fat — monounsaturated and polyunsaturated fats — do just the opposite. In fact, research shows that cutting back on saturated fat and replacing it with mono and polyunsaturated fats can help lower the level of LDL cholesterol in your blood.
If you smoke, it’s time to pack it in. According to the American Heart Association, smoking reduces your HDL cholesterol levels, while increasing your risk of heart disease, high blood pressure and diabetes. If you’re a smoker, you need to quit. Once you stop smoking, you can significantly improve your HDL cholesterol level very quickly and start protecting your heart. And if you’re a non-smoker, you need to avoid exposure to second-hand smoke to prevent your health from going up in smoke.
While it has been proven via multiple studies that elevated levels of low-density lipoprotein (LDL) contribute to the development of atherosclerosis, high-density lipoprotein (HDL) is widely thought to have atheroprotective effects. Results from multiple epidemiologic studies of healthy populations (most importantly, from the Framingham Heart Study) have given rise to the idea that high HDL levels protect against coronary heart disease (CHD). Patients with known CHD have been found to have lower levels of HDL. [1, 2]
For women after menopause, a study published in August 2016 in the journal Diabetes & Metabolism found that high intensity interval training (on a bicycle) led to better HDL cholesterol levels as well as significant weight loss. And a study published in May 2016 in the journal Applied Physiology, Nutrition, and Metabolism found that obese men who engaged in aerobic interval training (running on a treadmill) or resistance training (with weights) just three days a week for 12 weeks had significantly increased HDL cholesterol when compared with obese men who did no training.
Hayek T, Chajek-Shaul T, Walsh A, Agellon LB, Moulin P, Tall AR, Breslow JL. An interaction between the human cholesteryl ester transfer protein (CETP) and apolipoprotein A-I genes in transgenic mice results in a profound CETP-mediated depression of high density lipoprotein cholesterol levels. J Clin Invest. 1992 Aug;90(2):505–510. [PMC free article] [PubMed] 

An under-valued element of bone and cardiovascular health is the role of Vitamin K2, which many individuals are unknowingly deficient in. Found in the Japanese breakfast delicacy “natto” (fermented soybeans), vitamin K2 not only helps remove calcium from the arteries and soft tissues to prevent atherosclerosis, but it also draws calcium into the bones to prevent the risk of fracture. Nattokinase, an enzyme found in natto, may help to increase HDL levels while lowering total cholesterol and LDL cholesterol levels, according to an Asia Pacific Journal of Clinical Nutrition study.
All cherries are delicious, but there's something extra special about this sour variety. "I love snacking on dried Montmorency tart cherries not only because they have a sour-sweet flavor, but because they also have fiber," Gorin says. "Plus, you get other heart-helping benefits, too. Anthocyanins, a type of antioxidant found in purple and dark red fruits and vegetables, may help decrease the risk of heart attack in women."
Sugar and spice and everything nice… except for the fact that recent data has shown that added sugar is not so nice for our cardiovascular health or waistlines. In fact, a study published in Circulation found that people with the highest consumption of added sugars show significantly lower HDL levels. To cut back on your added sugar intake and increase HDL levels, consider replacing sugar with dates when you’re making baked goods like homemade granola bars, cookies, and cakes. It’s one way to slice total added sugars in half and will also give your sweet treat extra fiber, vitamins, and minerals.
A study of over 1 million US veterans showed a U-shaped relationship between HDL and total mortality, with 50mg/dL as the level associated with the lowest mortality. [7, 2] In addition, an analysis of the Framingham study demonstrated that LDL and triglyceride levels modify HDL’s predictive value; CHD risk was found to be higher when low HDL was combined with high LDL and/or triglycerides as compared with the presence of low HDL levels alone. [8, 2]  The relationship between HDL and CHD risk is also confounded by the presence of pro-atherogenic and inflammatory markers. [2]

It’s harder to increase HDL or "good" cholesterol than it is to lower LDL or total cholesterol. It’s estimated that up to 80 percent of the variation in HDL from person to person is due to genetic factors. But the following steps have been shown to boost HDL—and they are worth taking because they also lower total cholesterol and help protect the heart in many ways beyond their effect on HDL.
Trans fats increase your LDL cholesterol, reduce your HDL levels and raise your risk of developing heart disease, stroke, diabetes and other chronic conditions. Trans fats lurk in fried foods, stick margarine, cookies, crackers, cakes, pie crusts and frozen pizza. Today, some food manufacturers are removing them from their products, but the only way to tell if a product is trans fat-free is to read labels while you’re shopping. Avoid products that list “partially hydrogenated oil” in the ingredients, since this is just a sneaky name for trans fats.
Olive oil is a plant-based fat, so it's a better choice when you're trying to lower your "bad" cholesterol than fats that come from animals. It’s great mixed with red wine vinegar, a minced garlic clove, and a little ground pepper for a salad dressing. For something different, try braising vegetables like carrots or leeks. Just drizzle 3 tablespoons of oil over vegetables in a snug baking dish, scatter some herbs, cover with foil, and put in a 375-degree oven for about 45 minutes.
Raise your glass for heart health! In moderation, alcohol is known to raise HDL, or "good," cholesterol. Drinking a daily glass of red wine increased "good" HDL cholesterol and also decreased "bad" LDL cholesterol after a few months, found one study. Red wine also contains antioxidants called polyphenols that help keep your blood vessels healthy and strong. Remember that moderation means one drink for women or two for men daily and, in this case, more is not better.
In fact, moderate alcohol consumption has actually been linked with higher levels of HDL cholesterol. (6) Moderate consumption for healthy adults is one alcoholic drink per day for women of all ages and men over 65 and up to two drinks per day for mean 65 and under. Organic red wine is a smart choice, but don’t start drinking just to improve HDL levels because overdoing does much more harm than good — both for cholesterol levels and your overall health.
A meta-analysis looked at randomized controlled trials for artichoke extract for high cholesterol. They found three studies worth analyzing and two showed some effect in lowering total cholesterol. Adverse events were mild, transient, and infrequent. The study said that larger clinical trials over longer periods are needed. The conclusion was that the evidence was not convincing, and the Cochrane Review discontinued updating its analysis of this research as of 2016.
Treatment of high cholesterol usually begins with lifestyle changes geared toward bringing levels down. These include losing weight if you’re overweight, and changing your diet to emphasize vegetables and fruits, fish, particularly cold water fish such as wild Alaskan salmon, mackerel, herring and black cod that provide heart healthy omega-3 fatty acids. If lifestyle changes don’t help or if you’re unable to make the changes your doctor recommends, cholesterol-lowering drugs may be prescribed. These include statins, which effectively lower LDL cholesterol; bile acid sequestrants that may be prescribed along with statins to lower LDL; nicotinic acid to lower LDL cholesterol and triglycerides and raise HDL; drugs called fibrates that may be prescribed to lower cholesterol and may raise HDL; and a drug called Ezetimibe to lower LDL by blocking the absorption of cholesterol in the intestine.
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society
First, a quick explainer: Cholesterol is a waxy substance that travels through your bloodstream, but not all of it is bad. HDL cholesterol (a.k.a. "good" cholesterol) actually sweeps away LDL cholesterol, or the "bad" kind. A high LDL level puts you at risk for heart attacks and strokes because it can clog arteries with plaque, a condition called atherosclerosis. A blood test can determine whether you have high cholesterol, and your doctor may recommend exercise or medication in addition to a healthier diet.
“If your LDL levels are still too high after trying these 6 nutrition-based approaches, talk to your doctor about cholesterol-lowering medications like statins, but give these 6 tips your best shot,” encourages Dr. Danine Fruge, MD, ABFP, Medical Director at the Pritikin Longevity Center. “The right eating plan, like Pritikin, can be powerfully beneficial – and there are no adverse side effects.”
Rich in omega-3 fatty acids and all-around delicious, walnuts have also been shown to improve the HDL-to-total cholesterol ratio, according to a study published in the American Diabetes Association’s peer-reviewed journal, Diabetes Care. This ratio is used by physicians to assess overall cardiovascular risk and can provide more information than just one value alone. A desirable ratio is anything below 5:1, but a ratio of 3.5:1 indicates very minimal cardiovascular risk.
If you skip breakfast, you might want to give the most important meal of the day another shot. Women who eat a bowl of fiber-rich cereal every morning have lower levels of cholesterol than those who don't eat breakfast at all. It's all thanks to the fiber: "Fiber binds with cholesterol and speeds its excretion before it reaches your arteries," says Tanya Zuckerbrot, RD.
Take fish oil. Fish oil contains an abundance of essential omega-3 fatty acids (omega-3s) that have been shown to lower triglyceride (blood fat) levels, minimize inflammation and clotting, and increase HDL (“good”) cholesterol. Research indicates that omega-3s may help reduce the risk and symptoms of a variety of disorders influenced by inflammation, including heart attack and stroke. You can add omega-3s to your diet by eating more cold water fish such as wild Alaskan salmon, sardines, herring, mackerel and black cod. If that’s not possible, Dr. Weil recommends taking two grams daily of a fish oil supplement that contains both essential omega-3 fatty acids, EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid). When choosing a supplement, look for one derived from molecularly distilled fish oils – these are naturally high in both EPA and DHA and low in contaminants. Also choose a supplement brand that has been independently tested and guaranteed to be free of heavy metals such as mercury and lead, and other environmental toxins including polychlorinated biphenyls, also known as PCBs.
Swap extra-virgin olive oil for all your other oils and fats when cooking at low temperatures, since extra-virgin olive oil breaks down at high temperatures. Use the oil in salad dressings, sauces, and to flavor foods once they’re cooked. Sprinkle chopped olives on salads or add them to soups, like in this Sicilian fish soup. Just be sure to use extra-virgin olive oil in moderation, since it’s high in calories.
There's no magical food to keep your heart healthy, but there are a lot of foods that can help—including these foods that help lower your cholesterol. In addition to cutting back on foods that can raise total cholesterol and getting enough exercise, make sure to eat more of these foods that improve your cholesterol profile by raising "good" HDL and/or lowering "bad" LDL cholesterol. These foods include some old standbys, such as oatmeal and fruit, plus a few surprising foods that can help lower cholesterol to reduce your risk of heart attack and stroke.
George T Griffing, MD is a member of the following medical societies: American Association for the Advancement of Science, International Society for Clinical Densitometry, Southern Society for Clinical Investigation, American College of Medical Practice Executives, American Association for Physician Leadership, American College of Physicians, American Diabetes Association, American Federation for Medical Research, American Heart Association, Central Society for Clinical and Translational Research, Endocrine Society
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