Even people far from medicine know that high cholesterol is bad. However, why this indicator is so important is not clear to everyone. We’ll tell you what cholesterol is, how bad cholesterol differs from good cholesterol, how to reduce its level without medications, and what to do if diets don’t help.
Cholesterol is an important indicator of human health. If its level is elevated, you need to adjust your diet and sometimes take medications prescribed by your doctor. Together with an expert, we will analyze what cholesterol is, what it affects and how to reduce its level, if necessary.
The chemical name for cholesterol is cholesterol; in a blood test, this indicator is usually designated as Chol (сholesterol) or TC (total cholesterol). This fat-like substance is found in cell membranes and is involved in the synthesis of hormones, bile acids and vitamin D. However, when assessing cholesterol levels, not everything is so simple: it is divided into “good” and “bad”.
To get into tissues, cholesterol needs transport complexes – low-density lipoproteins (LDL) and high-density lipoproteins (HDL).
LDL carries cholesterol from the liver to cells, the latter take as much of the substance as needed and accumulate the excess. This accumulated cholesterol is called “bad” cholesterol.
HDL is involved in the reverse transport of cholesterol from cells to the liver. Cholesterol, which is synthesized in the liver into bile acids, is considered “good.”
Why lower your cholesterol levels?
This substance plays a key role in metabolism, without it metabolism would be impossible, so it is wrong to demonize cholesterol. But its excessive content in the blood also negatively affects health. One of the most dangerous consequences of high cholesterol is atherosclerosis.
Due to disturbances in lipid metabolism, cholesterol is deposited in blood vessels and forms atherosclerotic plaques. They narrow the lumen and clog the vessel, interfering with blood circulation, and this is fraught with heart attack and stroke .
To prevent this, you need to control the level of total cholesterol in the blood. Important: normal values will differ depending on gender and age.
Cholesterol levels for men and women
| Age | Men, mmol/l | Women, mmol/l |
| 20-30 years | 3.16—6.32 | 3.16—5.75 |
| 30-40 years | 3.57—6.99 | 3.37—6.27 |
| 40-50 years | 3.91—7.15 | 3.81—6.86 |
| 50-60 years | 4.09—7.15 | 4.20—7.77 |
| 60-70 years | 4.12—7.10 | 4.45—7.85 |
| over 70 years old | 3.73—6.86 | 4.48—7.25 |
Symptoms of high cholesterol
Hypercholesterolemia, or high cholesterol, has no obvious symptoms. Patients with high scores usually have no pain, nothing bothers them. However, there are indirect signs that should prompt you to check your cholesterol levels. Here are the main symptoms of hypercholesterolemia:
- xanthomas – benign formations on the skin of a yellowish-white color, most often appear on the eyelids;
- corneal arch – a white ring (lipid deposits) along the edge of the cornea.
In advanced cases, when plaques appear in blood vessels due to high cholesterol, heart problems may appear:
- dyspnea;
- convulsions;
- chest pain;
- heart rhythm disturbance.
8 ways to lower cholesterol without drugs
If the level of cholesterol in the body is elevated and dyslipidemia (an imbalance in the fat ratio) is observed, it is necessary to change your lifestyle. This is the first line of therapy. We tell you what to do to normalize the situation.
1. Eat monounsaturated fats
If you want to lower your cholesterol, you don’t need to completely eliminate fat from your diet. Research shows that a low-fat diet actually reduces levels of low-density lipoprotein (LDL), or “bad” cholesterol. At the same time, the level of “good” cholesterol, high-density lipoprotein (HDL), decreases.
Monounsaturated fats, on the contrary, reduce bad cholesterol and do not affect good cholesterol. They also prevent the oxidation of LDL, which causes atherosclerotic plaques to grow more slowly.
There are a lot of monounsaturated fats in olive and canola oil, tree nuts ( almonds , walnuts, hazelnuts, cashews) and avocados .
2. Eat polyunsaturated fats
They lower levels of “bad” cholesterol (LDL) and reduce the risk of heart disease. For example, in one experiment, Norwegian scientists from the University of Oslo replaced saturated fats with polyunsaturated fats in the diets of 115 adults. After eight weeks, total and LDL cholesterol levels dropped by 10% (1).
Another study from Harvard Medical School included 13,614 adults. They replaced 15% of total calories with polyunsaturated fat. The risk of developing coronary heart disease decreased by almost 20% (2).
Polyunsaturated fats also reduce the risk of developing metabolic syndrome and type 2 diabetes. It is enough to replace 5% of the calories of your entire diet with polyunsaturated fats to reduce the risk of this disease.
There are a lot of polyunsaturated fats in walnuts, fish (salmon, tuna, trout) and in vegetable oils: soybean, corn and sunflower.
3. Avoid trans fats
These are solid fats that are made from liquid vegetable oils using a chemical hydrogenation procedure. That’s what they’re called: hydrogenated fats. They are very harmful to health: they increase the amount of “bad” cholesterol and reduce the level of “good” cholesterol.
A 2016 study published in the Journal of the American Heart Association found that trans fats are responsible for 8% of deaths from cardiovascular disease (3). Another study claims that a law restricting trans fats in New York would reduce deaths from heart disease by 4.5% (4).
Trans fats include margarine and spreads. There are also a lot of them in ready-made baked goods and confectionery products.
4. Add soluble fiber to your meals
It is needed by beneficial bacteria that live in the intestines. These microorganisms reduce the level of low and very low density lipoproteins.
For example, in a study by scientists from the University of Minnesota, a group of men ate oatmeal with soluble fiber for breakfast for six weeks. As a result, their cholesterol levels decreased by 4–6% (5).
Soluble fiber is abundant in beans, peas, lentils, fruits, oats and whole grains. You can also take special nutritional supplements with this component (psyllium).
5. Exercise
An analysis of 13 studies published in the journal Sports Medicine found that just 30 minutes of physical activity five days a week is enough to normalize cholesterol levels and reduce the risk of heart disease. Even low-intensity exercise, such as race walking, is suitable (6).
A 2019 study of 425 older adults found that moderate physical activity lowered blood pressure, lowered blood sugar, and increased levels of “good” HDL cholesterol (7).
Another bonus of physical exercise: it helps you lose weight.
6. Lose excess weight
Even a few extra pounds contribute to high cholesterol levels.
A two-year study by Swiss scientists from the Institute of Clinical Chemistry in Bern found that weight loss increases healthy cholesterol. The level of harmful substances does not change (8).
7. Quit smoking
Normally, immune cells remove cholesterol from the walls of blood vessels into the blood for transport to the liver. In smokers, this mechanism is disrupted, which is why atherosclerotic plaques grow faster. Research confirms this.
For example, a four-year follow-up of more than 7,000 cases of heart attack and stroke showed that smoking is associated with an increase in total cholesterol and a decrease in good cholesterol (9).
Giving up a bad habit allows you to reverse this process.
8. Avoid alcohol
There is limited evidence that moderate amounts of wine raises HDL levels and reduces the risk of heart disease. In one small study, Dutch researchers found that drinking 24 grams of white wine alcohol daily increased HDL levels by 5%. There were no such changes in those subjects who drank grape juice (10).
Another study suggests that alcohol also improves the reverse transport of cholesterol from vessel walls into the blood and liver (11). This reduces the risk of clogged arteries. However, further research is needed to confirm this. So if you don’t drink alcohol, you shouldn’t start.
If you drink, do so in moderation. Adult women of any age and men over 65 years of age are allowed one drink of alcohol per day. Men under 65 – up to two per day. One serving is a mug of beer (330 ml), a glass of wine (140 ml) or a glass of vodka (40 ml) (12).
But the main thing is to remember that complete abstinence from alcohol is always better than partial.
According to a large-scale study conducted over 26 years, even small doses of alcohol have negative effects on the body.
What you can and cannot eat if you have high cholesterol
The first thing to do if you have high cholesterol levels is to adjust your diet. It is important to pay special attention to fats in the diet: give preference to polyunsaturated and monounsaturated fats, and minimize the consumption of trans fats and saturated fats.
| Can | It is forbidden |
| Lean beef | Fatty pork |
| Chicken | Mutton |
| Wild duck | domestic duck |
| Rabbit meat | domestic goose |
| Turkey without skin | Sausage products (sausages, sausages, sausages, ham) |
| Fatty sea fish (salmon, chum salmon, pink salmon, tuna) | Sprats |
| Low-fat river fish (perch, pike, bream, pike perch, carp) | Fatty river fish (crucian carp, carp, ruff) |
| Vegetable oils (olive, flaxseed, sunflower) | Margarine |
| Lactose-free milk | Butter |
| Low-fat kefir | Fermented milk products with high fat content |
| Low-fat cottage cheese | Full fat milk |
| Yogurt | Fermented milk products with a fat content of more than 10%, sour cream, cottage cheese, yogurt, ice cream) |
| Low-fat cheeses (ricotta, mozzarella, chechil, tofu) | Fat cheeses (Roquefort, mascarpone, Camembert, Gouda, cheddar, Gorgonzola) |
| Egg whites | Egg yolks |
| Fruits | Confectionery |
| Raw vegetables | Potato |
| Dried fruits | Fried vegetables |
| Wholemeal bread | White bread |
| Homemade crackers | Butter pastries |
| Durum wheat pasta | Sweet carbonated drinks |
| Beans (beans, lentils, chickpeas) | Polished rice |
| Nuts (walnuts, almonds, hazelnuts, pine) | Coconut |
| Low-fat desserts (jelly, skim milk pudding) | Fast food |
What to do if these methods do not help lower cholesterol
Your doctor should evaluate your cholesterol levels. When analyzing risks, not only laboratory values of total cholesterol are taken into account, but also concomitant diagnoses and family history. With dyslipidemia, it is important not only to follow a diet, but also to adhere to the principles of a healthy lifestyle: stop smoking, limit alcohol consumption, exercise, and improve sleep patterns.
If the risks of developing heart pathologies due to hypercholesterolemia are too high and lifestyle modification does not bring the desired results, the doctor may suggest drug therapy. In practice, statins, bile acid sequestrants, cholesterol absorption inhibitors, PCSK9 inhibitors, or combinations of these drugs are used.
Doctor’s advice
— Monitoring lipid profile indicators is very important. – explains Alena Chernikova, endocrinologist, candidate of medical sciences, senior researcher at the Institute of Endocrinology of the Almazov National Medical Research Center . — Among the risk factors for cardiovascular diseases, there are two components from the lipid spectrum: triglycerides and high-density lipoprotein cholesterol (HDL-C). But cholesterol is not an enemy, but an important component of metabolism. Only its excess or an incorrect ratio of low- and high-density lipoproteins (when there is a lot of “bad” cholesterol and little “good”) lead to dangerous consequences.
Normally, the body copes with the distribution of lipoproteins into “good” and “bad” on its own. But there are factors that lead to disruption of this balance:
- bad habits, such as smoking;
- unbalanced diet;
- lack of physical activity;
- excess weight;
- some endocrine pathologies;
- disturbances in the gastrointestinal tract;
- genetic predisposition.
By adhering to the principles of a healthy lifestyle, you can immediately correct four reasons that lead to increased cholesterol.
In a healthy person without pain or other symptoms, the thought of checking the condition of blood vessels or finding out cholesterol levels usually does not arise. This is why many patients at first are not even aware of problems with lipid metabolism.
The following categories of people need to regularly check their cholesterol levels:
- patients with hypertension;
- women in menopause;
- men over 40 years old;
- overweight people;
- patients leading a sedentary lifestyle;
- patients with cardiovascular pathologies;
- smoking patients.
Questions and answers
Endocrinologist Alena Chernikova answers popular questions about cholesterol and ways to reduce it.
What are statins and how do they help lower cholesterol?
If there are indications for monitoring the lipid spectrum (they are determined by the doctor, taking into account individual risks), it is necessary to take special medications. Among them are statins. The mechanism of action of statins is based on the active suppression of the enzyme responsible for the synthesis of cholesterol in the liver. Statin therapy is officially recognized as the most effective treatment for hyperlipoproteinemia. This is the only group of drugs that affects all indicators of the lipid spectrum. There is no need to be afraid of statins: the consequences of atherosclerosis – heart attack and stroke – are much worse.
Is it possible to drink coffee if you have high cholesterol?
The FDA recommends that it is safe for adults to consume up to 400 mg of caffeine per day. This is approximately 4-5 cups of coffee. Moreover, men are better off with less than women.
Much depends on the coffee itself: variety, roast, portion. Cafestol and caveolae contained in coffee, on the one hand, increase total cholesterol levels, on the other, have an anti-inflammatory effect, have a good effect on the liver and reduce the risk of developing diabetes and cancer.
Is low cholesterol harmful?
We have already said that cholesterol is used to build all the cells of the body. Therefore, excessive reduction of cholesterol is not beneficial.
What sweets can you eat if you have high cholesterol?
The increase in “bad” cholesterol is caused by animal fats, which are found in most sweets. Therefore, it is advisable to completely exclude products that use margarine, butter, milk, and cream from the menu.
But you don’t need to completely give up sweets. Confectionery products can be replaced with sweets of plant origin, which, on the contrary, are useful to use for lipid metabolism disorders. For example, it could be kozinaki or pastila. But please note that high cholesterol levels are often combined with carbohydrate metabolism disorders (prediabetes and diabetes mellitus); in such cases, the consumption of any sweets should be limited.