Beyond Medication for Lowering LDL

Medically Reviewed by James Beckerman, MD, FACC on May 23, 2024
3 min read

Cholesterol meds can be important, even life-saving tools in your cholesterol-control toolbox. But they’re not cure-alls. Lifestyle changes are just as key for managing your cholesterol.

In fact, for most people with high cholesterol, doctors recommend lifestyle changes as your first step.

How medications work

Your doctor has several options when prescribing cholesterol meds. Each one works differently:

  • Statins prevent your liver from making cholesterol in the first place, which lowers the amount in your bloodstream.
  • Cholesterol absorption inhibitors (Ezetimibe) prevent your intestine from absorbing cholesterol. Your doctor might add this to your medication regimen if statins alone aren’t working.
  • Bile acid sequestrants can lower your LDL levels (the “bad” cholesterol) by blocking bile acid in your stomach from being absorbed in your blood so that your liver uses cholesterol from your blood to make more bile acid.
  • PCSK9 inhibitors lower your LDL levels by latching onto and inactivating a protein on cells found in your liver.
  • Adenosine triphosphate-citrate lyase (ACL) inhibitors work in your liver to block production of cholesterol.
  • Fibrates raise your levels of HDL (“good” cholesterol).
  • Niacin (nicotinic acid) slows down production of blood fats in your liver.

But meds work best to improve your cholesterol levels when you pair them with smart lifestyle habits for your overall wellness. These include:

Dial in your diet

Just a few tweaks in your diet can tone down cholesterol levels and improve your heart health:

  • Reduce saturated fats. When you lower the amount of red meat and full-fat dairy products you eat, you lower your LDL levels.
  • Cut out trans fats. These cholesterol-raisers hide out in margarine as well as store-bought cookies, cakes, and crackers. You can find trans fats on the label as partially hydrogenated vegetable oil.
  • Bump up your omega-3 fatty acids. Although they don’t reduce LDL levels, foods high in these fatty acids can reduce triglycerides. Reach for walnuts, avocados, flaxseeds, or fish such as salmon, mackerel, and herring for a dose of omega-3s.
  • Switch to a plant-based diet. Foods like beans, legumes, and spinach can lower your cholesterol while providing lots of protein.
  • Fill up on soluble fiber. Foods like oatmeal, kidney beans, Brussels sprouts, apples, and pears are high in fiber and reduce the amount of cholesterol that gets absorbed in your bloodstream.
  • Add whey protein. You find this in dairy products. Studies show it can lower your LDL levels, total cholesterol, and even blood pressure.

Add supplements

Note these are meant to boost your nutrition, not replace food in your diet. And your doctor should always know if you’re adding a supplement to your daily routine. But if you get the all-clear, you may reap benefits from options such as:

  • Psyllium. You can get this fiber laxative over the counter in powder, capsule, or even wafer forms. Psyllium finds cholesterol and eliminates it from your body. A typical dose is about 2 grams a day.  
  • Red yeast rice. Your doctor will likely monitor your liver function if you take this yeast grown on rice. It shares compounds with some cholesterol-lowering medications such as lovastatin. You take about 1,200 milligrams twice a day in pill form.
  • Phytosterols. Just 2 grams a day of these compounds found in plant cell membranes can lower your cholesterol by 10% and your LDL by 14%. Phytosterols are similar to natural cholesterol. Because of this, they compete with cholesterol during digestion, lowering the amount of cholesterol that stays in your system. 

Toss out tobacco

No matter the form, tobacco harms your heart. The nicotine in tobacco raises cholesterol and greatly increases your risk of heart disease. Studies show people who smoke have lower levels of HDL, higher LDL, and higher total cholesterol compared to nonsmokers. 

Build a strong heart

Want to kick-start a cholesterol-lowering spree? Get moving. Regular exercise raises HDL and lowers triglycerides, another type of lipid in the blood that can lead to hardened arteries.

The key is for your physical activity to be consistent, aerobic, and to involve different muscle types.

The American Heart Association recommends 30 minutes a day, 5-7 times a week. You may also lose extra weight as a result of regular exercise, which helps your HDL go up and your LDL go down.