Have high cholesterol? Here's a practical approach to managing it.

Your doctor just told you your cholesterol is high. As it turns out, you've got plenty of company.

Millions of Americans are managing high cholesterol right now. And while measurements like "milligrams per deciliter (mg/dL)" on your lab report might seem confusing at first, understanding them is a big step toward better heart health.

High cholesterol matters because it's one of the key things that can affect your heart health and stroke risk. The good news? It's also one of the things you can actually do something about.

What is cholesterol

Many people cringe at the word. But cholesterol is natural and necessary. Your body needs this waxy fat-like substance to build and repair tissue. It also helps produce certain hormones and aid digestion. Learn more about what cholesterol does.

It’s easy to have too much cholesterol in your system — especially as you get older or if it runs in your family.

You’ve probably heard about “good” and “bad” types of cholesterol and triglycerides. Sometimes, people find that digging into the details only makes it more frustrating.

“My best advice is to talk with your primary care provider,” says Eric Muller, MD, a heart and lipid specialist at PeaceHealth in Springfield, Oregon. “Your PCP can help you understand your test results and look at what might be driving your numbers.”

You might also find clinics that specialize in cholesterol management. PeaceHealth has a lipid clinic at Riverbend that welcomes all patients for personal risk evaluation.

Read more about cholesterol testing.

What causes high cholesterol

Causes of high cholesterol vary. These are some things that can have an impact:

• Family history — genetics are the most important factor
• Age — cholesterol can trend up as you get older
• Body weight
• Type 2 diabetes
• Smoking
• Not enough exercise (less than 150 minutes per week)
• High levels of saturated and trans fat in the diet

While these are typical, cholesterol isn’t always straightforward. You can be a thin nonsmoker and still have high cholesterol. Other things might account for higher levels. That’s why it’s helpful to get a professional opinion. Learn more about common misperceptions in the American Heart Association’s cholesterol guide.

You and your doctor can discuss what you can do to bring your own levels into better balance.

3 ways to affect your readings

There are three key measures usually recommended to manage cholesterol. Here’s what proven to be effective and how each approach works:

1. Food and drink. 

What you eat can affect your cholesterol because foods such as saturated fats and sugar can prompt your liver to make more cholesterol. Instead, opt more often for food and drinks that don’t have that effect. Some foods such as oats can even help by removing excess cholesterol.

The American Heart Association and the National Lipid Association recommend a Mediterranean style diet.

Better-for-you choices

As part of an overall healthy eating plan, consider these:

• Healthy fats don’t trigger cholesterol production. They also reduce inflammation in the body, which can lead to heart disease, asthma, chronic pain and other conditions. And fats help you feel full. A few good ones include:
  • Extra virgin olive oil
  • Avocados and avocado oil
  • Cod liver oil
• Fruit and veggies with pectin attract cholesterol molecules and carry them out of the body. Some examples include:
  • Apples with skin
  • Bananas
  • Carrots
  • Pears
  • Tomatoes
• Fiber-rich foods help remove cholesterol through the waste system (poop). These include:
  • Beans
  • Chia seeds, which also have omega 3 that drive down triglycerides.
  • Legumes such as lentils.
  • Nuts, especially pistachios, almonds, walnuts. Note: go easy as overdoing nuts can result in weight gain, upset stomach and other negative side effects.
  • Whole grains like oats and barley; some have a substance called beta glucan, which keeps cholesterol from sticking to the inside of your intestines.
• Antioxidant foods lower inflammation, which can prevent cholesterol from sticking to arteries. Examples include:
  • Berries
  • Dark chocolate (70% cocoa or higher) in small amounts
  • Garlic
  • Green leafy vegetables like kale, chard and lettuce.
  • Green tea
  • Red grapes, especially the skin

Less-healthy choices

Whenever possible, limit or avoid foods that can trigger cholesterol production and increase inflammation. Aim to eat less than 10% of your daily calories from:

• Saturated fats:
  • Fatty cuts of red meat
  • Dairy products
  • Baked goods with palm oil or coconut oil
• Refined or “added” sugar in drinks and processed foods. These can raise your blood sugar, which spikes your insulin, a hormone that helps manage blood sugar. As a result, your liver may be triggered to produce more cholesterol.
• Alcohol can lead to liver damage. That makes it harder for the organ to do its job well.

Always drink plenty of water (eight or more 8-ounce glasses a day). This will help move waste through your system, especially if you’re eating more fiber.

“You may see a difference in cholesterol levels after just a few months of changing your eating habits,” says Dr. Muller. But everyone’s system is different. If your levels still aren’t where you want them to be after eating healthier, don’t be discouraged.

2. Exercise.  

Physically moving your body can lower your insulin and blood sugar. These can, in turn, lessen cholesterol production. One added benefit of exercise is that it builds or maintains muscle mass. Muscle helps your body use energy well. It can also help you get to or stay at a healthy weight.

Aim for 30 minutes a day, five to seven times a week. If that’s more than you can manage, start with what you can do. Try 5 to 10 minutes of movement throughout the day. Or longer sessions a couple of times a week.

“If it’s been a while since you’ve been active, start slow and gentle with something like walking, seated chair yoga or resistance training,” he says.

3. Medication.  

Millions of people take a daily statin to lower their cholesterol and reduce their risk for heart attack.

This type of medication was introduced in the 1980s. Studies show that statins are effective at lowering harmful cholesterol and reducing the frequency of heart attacks by about 30%.

It takes a few months to see cholesterol go down after starting a statin. A minority of people experience side effects. And once on a statin, you’ll likely need to stay on it. 

You might also appreciate knowing that newer treatments are available for patients who are not able to take statins.

“Medication can be remarkably helpful; however, you’ll still want to combine it with healthy lifestyle habits for the best results,” says Dr. Muller.

Like the millions of other people with high cholesterol, you can try various ways to lower your levels. Talk with your doctor to get started today.