People with high cholesterol usually fall into one of two groups. Those whose levels are so high that they need cholesterol -lowering medications such as statins to reduce their risk of heart disease. And those whose levels are elevated, but not so high that they require medication, said Dr Felipe Lobelo, a lifestyle medicine researcher at Emory University in Atlanta in the United States.

If people in the latter group have an otherwise low risk of heart disease, lifestyle changes should be their first step in trying to improve their health, according to the American Heart Association (AHA).

Your cholesterol refers to a measure of two types of particles in your blood: low-density lipoprotein (sometimes called “bad”) or LDL cholesterol and high-density lipoprotein (often referred to as “good”) or HDL cholesterol. When there’s too much LDL cholesterol in your blood, it can gum up your blood vessels, making it harder for your heart to pump blood through them.

For adults aged 20 or older, it’s generally considered healthy for LDL cholesterol levels in blood to be under 100 milligrams per decilitre. If your levels rise to as high as 189 milligrams per decilitre but your risk for heart disease is otherwise low, the AHA says, it may be worth trying certain lifestyle changes to bring your cholesterol down before you rely on prescription medication.

Levels that exceed 190 milligrams per decilitre typically lead to a statin prescription.

Certain lifestyle tweaks such as getting sufficient sleep, reducing tobacco use and managing stress can all help improve cholesterol levels. But two lifestyle choices in particular can yield much greater benefits, said Dr Frank B. Hu, a professor of nutrition and epidemiology at the Harvard T.H. Chan School of Public Health in the US.

Exercise

When we exercise, HDL cholesterol is released into the bloodstream, where it sweeps up fatty plaque deposits in the blood vessels and transports them to the liver for disposal.

The AHA recommends that all adults get at least 150 minutes of moderate exercise, or 75 minutes of vigorous exercise, per week, Dr Lobelo said. That can include walking, swimming, lifting weights, dancing or whatever else you enjoy and can do without injury, he added.

The key, he said, is to ensure that your heart rate is elevated enough. If you’re struggling to keep up your end of a conversation while exercising, Dr Lobelo said, that’s how you know you’re working hard enough.

Regular exercise can help lower your cholesterol, particularly if you didn’t exercise before, Dr Lobelo said. Though he added that it may take longer for some people to improve their cholesterol levels through exercise than others. So if it’s not coming down immediately, he said, don’t get discouraged.

Diet

Research also suggests that a plant-forward diet called the portfolio diet — which includes soy products such as tofu and other plant-based proteins such as beans, lentils and chickpeas; viscous-fibre-containing foods such as oats, barley, psyllium husk; berries, apples and citrus fruits; nuts and seeds; avocado; and healthy plant-based oils including canola oil and olive oil — can help lower cholesterol, said Andrea Glenn, a nutrition researcher at New York University in the US.

In a review of seven clinical trials that included 440 participants who had high cholesterol levels but didn’t require medication, researchers found that the portfolio diet helped reduce their LDL cholesterol by up to 30 per cent. That’s about as effective as the older versions of statin drugs that were widely used in the ’90s, Glenn said.

Glenn and her colleagues followed about 2,10,000 adults in the US for about 30 years in a study published in 2023. They found that those who closely followed this diet had a 14 per cent lower risk of cardiovascular disease than those who ate less of these foods, Glenn said.

The portfolio diet works because it combines various kinds of foods and nutrients that help lower cholesterol in different ways, she said.

Plant proteins like beans, chickpeas and soy products, for instance, can inhibit the production of apolipoprotein B, which normally helps your body take up cholesterol from foods. Viscous fibre traps or binds cholesterol in the intestines, making it harder to absorb. And nuts are good sources of unsaturated fatty acids, plant sterols and fibre, which can all lower LDL cholesterol levels.

Even adding or replacing a few foods — like adding nuts to your morning granola or swapping red meat with chickpeas or tofu — can help improve your cholesterol, Glenn said.

“There’s certainly no magic bullet,” Dr Hu said. But diet, exercise and other healthy habits can go a long way in helping to lower cholesterol. He said, “We have to think about it from a holistic point of view.”

NYTNS