High cholesterol is associated with an increased risk for cardiovascular conditions like heart disease, stroke, and atherosclerosis. If your doctor has recommended lowering your cholesterol, this guide can get you started.

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Cholesterol is a fat-like substance essential for healthy cellular functions throughout your body. It’s transported in the bloodstream by lipoproteins, compounds that carry cholesterol to and from different destinations like your muscles, liver, and intestines.

Low-density lipoprotein (LDL) and high-density lipoprotein (HDL) are the two main types of lipoproteins that transport cholesterol. You’ve probably heard of LDL referred to as the “bad” cholesterol and HDL referred to as the “good” cholesterol.

When your doctor says you’ve got high cholesterol, it usually means you have high LDL and low HDL. High LDL increases the likelihood excess cholesterol remains in your blood stream rather than being transported by HDL to the liver to be broken down. Over time, this can cause cholesterol to build up inside your vessels, contributing to cardiovascular disease (CVD).

The good news is you can manage your cholesterol levels successfully with lifestyle modifications and medication.

Check out this guide to lowering your cholesterol to get started.

After you’ve been diagnosed with high cholesterol, your doctor will recommend a treatment plan consisting of lifestyle modifications and medication, depending on your overall health and cardiovascular risk factors.

You may be prescribed a statin, a type of medication that lowers cholesterol by inhibiting cholesterol production in the liver. Start taking any medications as directed by your doctor during week 1.

Your eating habits are the perfect place to start when it comes to lifestyle modification. Saturated fats, trans fats, and cholesterol from animal products are all dietary ingredients that raise LDL. Saturated fat, in particular, raises your LDL more than any other dietary factor.

Week 1 kicks off immediate diet modifications. Focus on heart-healthy foods and reducing or eliminating sources of saturated and trans fats and cholesterol, which is heavily concentrated in the fat of animal meats and in certain processed foods.

Here’s what eating for lowering your cholesterol and cardiovascular risk can look like:

Include:

  • fruits and vegetables
  • whole grains
  • no-fat dairy
  • lean protein
  • nuts, seeds, and legumes
  • liquid non-tropical vegetable oils

Avoid:

  • alcohol
  • salt (sodium)
  • added sugars
  • saturated fats (full-fat dairy, processed meats, poultry skin, baked goods, palm and coconut oil)
  • trans fats (fried foods, potato chips, margarine, shortening)
  • processed foods

It’s OK to make small changes during the first week. Set a reasonable goal for yourself, like making the move to skinless chicken or switching from coconut oil to olive oil.

Week 1’s plan might look like:

  • swapping full fat milk for almond milk in your coffee
  • adding a vegetable side to one daily meal
  • using olive oil for cooking instead of coconut oil or butter
  • buying whole grain bread instead of white
  • replacing sweetened beverages with water or unsweetened tea

During week 2, dietary changes are still a priority, but it’s time to build on them (set some new goals) and add another area of focus for lowering cholesterol.

The next step is to get your body moving. Aerobic exercise helps raise your HDL levels and lower your LDL. It promotes weight management, supports overall cardiovascular health, and reduces inflammation in the body.

A position statement from the American Heart Association (AHA) in 2021 recommends exercise be a first-line therapy for all people working to lower their cholesterol.

How much do you need? The AHA recommends 150 minutes of moderate physical activity a week, or 75 minutes of vigorous physical activity a week.

Like week 1, week 2 is about attainable goals. Getting more exercise than usual, at a pace suitable for your health and physical fitness level, is where you should start.

Walking is a great starting point. Go at your own pace, gradually increasing you time and effort as your fitness improves.

Week 2’s plan might look like:

  • finding dairy substitutes
  • focusing on lean proteins
  • eating vegetables at every meal
  • taking a 15 minute walk each day

During week 3, your diet and exercise goals should progressively gain traction. You probably haven’t completely overhauled your meal plan yet, and you might still be exploring different ways to increase your activity — and that’s all OK. Consistency is key.

If you haven’t already, week 3 is a good time to incorporate stress reduction strategies and weight loss habits.

Psychological stress can increase your LDL and lower you HDL, so finding effective management options is helpful.

Stress management options to consider include:

  • meditation
  • deep breathing or breath exercises
  • structured counting
  • mindfulness
  • mind-body arts, like Tai Chi

Weight management should also become a priority once you’ve gotten into healthier eating and activity habits. Obesity is linked to high LDL and low HDL. It’s also a factor for conditions like type 2 diabetes that can also elevate LDL levels.

A good way to start orienting yourself toward weight loss is to start tracking your calories consumed versus your calories utilized. To lose weight, you’ll want to strive for a caloric deficit.

Week 3’s plan might look like:

  • eating heart-healthy meals at each meal
  • walking for 30 minutes a day or transitioning to light jogging
  • testing relaxation strategies several times a week
  • tracking calorie consumption and usage with a journal or tracking app

By week 4, your core lifestyle modifications and medication therapy should be well underway. If you haven’t finalized your diet, now’s the time. Make that final switch to fruits and veggies, cut out the salt, and avoid those processed meats.

Increase your exercise as appropriate. Moderate-intensity exercise should increase your heart rate and respiration. You should still be able to talk, but not be able to sing during the activity. If it feels too easy, consider increasing your effort or exercise duration.

Keep practicing your stress management. It can take time to become proficient, but working at it every day, or at least on a regular schedule, is how you’ll improve.

Week 4 is also when you’ll be able to have your first fasting lipid panel monitoring done if you were started on a statin, though your doctor may wait up to 12 weeks depending on your individual circumstances.

Week 4’s plan might look like:

  • eating heart-healthy meals at each meal
  • regularly adjusting exercise as your fitness improves
  • practicing stress management regularly during the week
  • speaking with your doctor about lipid testing

Your second month of lowering cholesterol is about the details. You’ve been including heart-healthy foods and cutting out those that increase your cholesterol. Your exercise routine is regular and you’re feeling your fitness level improve.

Now it’s time to start adding other healthy lifestyle habits, like monitoring portion sizes, tracking your caloric intake, and monitoring your progress with journals or fitness monitors.

By 12 weeks, or the 3-month mark, your doctor will have re-assessed your cholesterol levels. Your progress is reviewed, and adjustments are made to your lifestyle or medications as needed.

Make any changes suggested and consider setting new goals to keep yourself motivated. Lifestyle modifications for lowering cholesterol are life-long. Even if your LDL successfully lowers, keeping up with your healthy habits is what will keep it within its desired range.

Stay motivated by trying new recipes, taking a culinary class, or signing up for an event, like a charity walk/run.

Sticking to a cholesterol-healthy lifestyle can be challenging, but these tips can help you maintain your forward progress even when faced with social pressures and times of indulgence, like family vacations:

  • Be kind to yourself. If you slip up on your healthy lifestyle habits, forgive yourself and then make it a point to get right back on track.
  • Get creative with alternative ingredients. It’s still possible to enjoy flavorful meals with cholesterol-friendly substitutions, like milk alternatives or non-alcoholic “mocktails.”
  • Recruit a friend to workout with. Having a companion when you exercise can help you stay motivated and can add a level of social enjoyment.
  • Reward yourself. Rearranging your lifestyle is hard. Celebrate your successes, but keep those rewards cholesterol-friendly.
  • Learn more about high cholesterol. An in-depth understanding of cholesterol, its role in the body, and the health complications that come from high cholesterol can reinforce your determination.
  • Take medications on time, as directed. Only change your medication routine if your doctor directly advises you to.
  • Stop smoking. While current research suggests smoking doesn’t affect LDL significantly, it can lower your HDL levels and increase triglycerides, another type of fatty molecule associated with cardiovascular disease risk.
  • Speak with a therapist or counselor. A mental health professional can help you develop positive thought patterns and coping mechanisms while you manage cholesterol.

The most important part of sticking to your cholesterol-healthy lifestyle is to keep up with your doctor visits. If you’re on statins, your cholesterol levels are checked every 3 to 12 months, and it can take 6 to 12 months to see the benefits of lifestyle changes.