Your cholesterol is too high. What now?
First, know that your cholesterol levels are not everything.
Many other things can increase your risk of heart disease besides “high cholesterol”, such as inflammation, crosslinking in your arteries, mitochondrial dysfunction, an unhealthy epigenome, micronutrient deficiencies, and so on.
Luckily, the tips we provide here will not only lower your cholesterol levels, but will also address those other important cardiovascular risk factors.
Before we highlight the best tips to reduce your cholesterol, you first need to know more about cholesterol and other factors that increase your risk of a heart attack.
Always put your cholesterol in perspective
Many people only focus on total cholesterol levels.
However, you can still be healthy even with high total cholesterol.
After all, if your HDL cholesterol (“good” cholesterol) is also high, your high total cholesterol level can still be okay.
Therefore, make sure you always look at your cholesterol ratio — not just your total cholesterol.
The cholesterol ratio is the ratio between your total cholesterol and your HDL cholesterol.
The cholesterol ratio is calculated by dividing your total cholesterol by your HDL cholesterol.
So if your total cholesterol is 240 mg/dl (which would be “too high”) but your HDL is 80 mg/dl (high good cholesterol) then your cholesterol ratio is 3.0 (240/80), which is good.
Your cholesterol ratio should be ideally 3.5 or lower. The higher your cholesterol ratio, the unhealthier, given it means there is too much unhealthy cholesterol circulating in your blood compared to healthy HDL cholesterol.
However, total cholesterol, HDL and LDL levels do not tell you everything regarding your cholesterol metabolism. There is much more to it.
“Cholesterol” is not just HDL, LDL and total cholesterol levels
Other factors besides HDL, LDL and total cholesterol levels are also important, such as the size of the cholesterol particles.
The smaller the cholesterol particles the unhealthier, given small particles can stick more easily to the blood vessels and “crawl” into them where they accumulate and lead to atherosclerosis (the clogging up of the blood vessels).
Also important is the degree to which cholesterol particles are glycated. “Glycated” means that sugar molecules stick to the cholesterol particles. The more the cholesterol is glycated, the unhealthier it is. Glycated (sugar-coated) cholesterol particles are much stickier than normal cholesterol particles.
Furthermore, how much the cholesterol particles are oxidized also impacts your heart disease risk. If you don’t eat enough foods that counteract the oxidation of cholesterol such as fruits and vegetables, your cholesterol particles will be too oxidized. This also makes them more sticky and dangerous.
Cholesterol particle size, glycation and oxidation of cholesterol particles are often not measured in standard blood tests.
However, there is more to cardiovascular health than cholesterol. Just looking at cholesterol would provide only a small snapshot of your overall cardiovascular risk. Many other factors that impact your heart health.
Why cholesterol is not everything
Besides cholesterol, many other factors play a role in heart disease, such as inflammation (e.g., as measured via ultra sensitive CRP), epigenetic changes in the cells that make up the blood vessels, the microbiome (the bacteria in your gut), the elasticity of your blood vessels, deposition of protein and crosslinks in the blood vessel walls (making them more stiff and prone to atherosclerosis), endothelial health (e.g., as measured via flow mediated vasodilatation), senescent endothelial cells, calcium levels in plaques and plaque stability (e.g., as measured via Cleerly Health – not sponsored), and so on.
So cholesterol levels are not everything.
However, the tips we provide here are not only great to reduce cholesterol levels, but also to address many of those other factors that increase your risk of heart disease — and of course also slow down aging.
How to reduce cholesterol
1. Follow a longevity diet
Diet is by far the most powerful way to reduce your cholesterol. Follow a science-based longevity diet, such as the NOVOS Longevity Diet.
Such diets are based on slowing down aging, and have the best science behind them to improve health. A longevity diet summarized in a nutshell:
– Consume more healthy fats: this means fats from olives, olive oil, avocado, walnuts, fatty fish, chia seeds, flax seeds, sunflower seeds, and so on.
– Consume more healthy proteins: this means eating less red meat (beef, pork, veal, mutton) and more white meat (poultry) and fatty fish (salmon, anchovy, mackerel, herring).
– Consume less sugars (soda, cake, cookies) and starches (bread, potatoes, pasta and rice).
Concretely, this means eating a few handfuls of (wal)nuts and seeds per day, consuming an avocado every day (e.g. for breakfast), eating fatty fish at least 4-5 times per week, replacing red meat with white meat and fatty fish, and replacing bread, potatoes, pasta and rice more with vegetables, pulses/legumes, mushrooms and quinoa.
Learn more about our science-based longevity diet here.
2. Increase your fiber intake
Fiber lowers cholesterol. Fiber binds cholesterol, so less cholesterol is absorbed. Fiber also improves the gut microbiome, which boosts heart health.
On average, people consume about 15 grams of fiber per day, which is too little. This should ideally be double (30 grams per day or more).
For each 10 gram of extra fiber intake per day, the risk of dying of a heart attack was reduced with 27% (R).
To increase your intake of fiber, consume lots of vegetables, legumes, oats, apples, pears, peaches, mushrooms and other fiber-rich foods.
3. Consume more oatmeal and mushrooms
Oatmeal and mushrooms contain substances that can bind cholesterol and lower cholesterol levels such as beta glucans. Beta glucans have been shown to reduce heart disease risk (R).
Make sure your oatmeal does not contain added sugars. Also make sure you use “raw” minimally processed oatmeal (“steel cut oats”, not rolled oats) that needs at least 20 minutes of cooking.
So steer clear from any oatmeal product that takes less than 20 minutes of cooking. Most oatmeal in the supermarket is such processed oatmeal, which often also contains added sugar and is prepared oatmeal (mostly ready in a few minutes), causing high sugar peaks leading to stiffer and unhealthier blood vessels.
4. Eat lots of nuts, especially walnuts
Nuts contain fiber, which lowers cholesterol. They are also filled with substances that improve cardiovascular health, like omega-3 fatty acids (walnuts) or vitamin E.
Of all nuts, walnuts are probably the healthiest choice. Walnuts are rich sources of omega-3 fatty acids, which improve cardiovascular health.
Hazelnuts and almonds are very rich in natural vitamin E, which is also important for blood vessel health.
A large study, involving more than 27,000 people, found that people who consume nuts at least seven times per week had 20 percent less risk of dying (R).
Try to consume at least 3 handfuls of nuts (walnuts, almonds, hazelnuts) or seeds (see below), daily.
5. Consume more heart-healthy seeds
Chia seeds and flax seeds contain vitamins, minerals and especially omega-3 fatty acids which are pivotal for proper vascular health.
Chia seeds, flax seeds (and walnuts) are thus excellent sources of plant-based omega-3 fatty acids.
Sunflower seeds contain high levels of vitamin E, which are needed for healthy blood vessels.
So consume at least 3 handfuls per day of seeds and/or nuts to improve your blood vessel health.
6. Consume dark chocolate
Dark chocolate is a very healthy treat, especially for your blood vessels.
Dark chocolate (made of ideally at least 70% cacao) contains flavonoids, which are substances that keep the blood vessels healthy and elastic.
A meta-analysis published in the British Medical Journal that looked at 114,000 patients found that people with the highest levels of chocolate consumption had a 37% reduction in cardiovascular disease and a 29% reduction in stroke compared to people with the lowest intake of chocolate (R).
Also, cocoa flavonols in dark chocolate can slow down brain aging and mild cognitive impairment in elderly people (R).
7. Blueberries and other blue fruits
Blue fruits such as blueberries and blackberries contain anthocyanins and other substances that keep our blood vessels healthy (and that can slow down aging).
For example, a study found that people who eat a cup of blueberries every day had 15% less risk of cardiovascular disease (R).
Blueberries also improve metabolism, including sugar levels, which play a role in glycation of cholesterol and heart disease in general.
For example, a study with 186,000 participants found that people who consumed a handful of blueberries each day had 27% less risk of type 2 diabetes, a condition that drastically increases the risk of heart disease (R).
8. Fresh pomegranate juice
Pomegranate juice has been shown to reduce oxidized cholesterol (the more dangerous cholesterol) and has been shown to reduce atherosclerosis (the clogging up of blood vessels).
People who drank one glass of pomegranate juice per day for a year saw the thickness of the intima and media (these are the inner layers of the blood vessels) decrease by 30%, while the control group who didn’t drink pomegranate juice saw the thickness of their artery walls increase by a few percentages.
Also, pomegranate juice reduced the amount of oxidized cholesterol by 90% (as we mentioned before, oxidized cholesterol is very unhealthy cholesterol).
Furthermore, the blood pressure of the participants decreased by 12%, which is quite impressive by medical standards (R).
Make sure you buy high-quality pomegranate juice that consists of 100% pure juice. Do not buy juices made from “pomegranate extract” with added sugar (as most pomegranate juices are).
9. Spice up your food
Herbs and spices are powerful foods to improve your health.
Herbs and spices contain substances that can lower inflammation, protect DNA, have epigenetic effects and modulate the gut microbiome.
Heart-healthy herbs are thyme, oregano, parsley, ginger, rosemary, and turmeric.
Garlic has been shown to improve the health of the blood vessels (R,R) and can reduce atherosclerosis. Ginger and turmeric can reduce inflammation. Too much systemic inflammation plays a role in atherosclerosis.
10. Increase your intake of potassium
Potassium is needed for proper cardiovascular function. It can lower blood pressure, and is especially good for blood vessels in the brain, in the sense it can reduce the risk of strokes.
Studies show that increasing the intake of potassium even a little significantly reduces stroke risk.
One study with more than 20,000 participants found that replacing regular salt (sodium chloride) more with potassium salt (potassium chloride) led to a decreased risk of stroke by 14%, cardiovascular events by 13% and death by 12% (R).
Likely, they could have done even better by replacing their normal salt with even more potassium (the salt in this study contained only 25% potassium chloride).
Another study that included more than 10,000 people found that for each 1000 mg of potassium intake, the risk of cardiovascular disease was reduced by 18% (R).
You can increase your intake of potassium by using more potassium salt (potassium chloride) instead of regular salt (sodium chloride). In many stores (or online) you can find “mixed salt”, which contains around 70% potassium chloride (potassium salt) and 30% sodium chloride (regular salt).
The more potassium chloride there is in your mixed salt, the better. However, keep in mind that potassium chloride has a bitter taste, so you should find a salt that has a ratio that works for you (Mortons makes a 50% “Lite Salt” that is pretty agreeable for most).
Learn more about the role of potassium in our health and how to increase its intake here (article coming soon).
11. Do not smoke
Smoking leads to unhealthy blood vessels and significantly increases your risk of a heart attack.
Exercise is a great way to keep your blood vessels healthy. Try to exercise at least 3 to 4 times per week for at least 30 minutes.
Regular exercise can significantly reduce your risk of a heart attack.
13. Avoid vegetable oils
Vegetable oils like corn oil, canola oil, sunflower oil, salad oils, dressing, etc. are highly processed. They can wreak havoc on your arterial walls; our bodies have a very hard time to properly process these kinds of fats.
Also, these oils often contain large amounts of omega-6 oils, which increase inflammation.
Instead of corn oil, sunflower oil, and canola oil, consume olive oil (ideally), and a little bit of walnut oil (for cold dishes), and avocado oil for cooking.
14. Watch out with coconut oil
Coconut is being touted by some people as being very healthy. Having looked at both sides of this complicated story, we have our reservations about coconut oil: we don’t believe that consuming large amounts of coconut oil is healthy in the long term.
Some fats in coconut oil can be healthy (like caprylic acid), but other fats in coconut oil, especially the longer-chained ones, can promote inflammation or lipotoxic stress in our cells.
However, using small amounts of coconut oil to cook is ok. With that said, don’t take spoonfuls of extra coconut oil per day “for heart health”.
15. Limit your alcohol
Until quite recently, it was thought that a little alcohol in moderation could be a healthy thing.
However, large and more recent studies have shown that even a small amount of alcohol can quickly increase the risk of heart attacks, stroke, pancreatitis, and higher mortality overall.
Therefore, we recommend drinking a maximum of one glass of alcohol per day, and to include alcohol-free days.
16. Avoid “cholesterol lowering” margarines
These margarines contain large amounts of omega-6 fats, which can cause inflammation and further pull askew the omega-6 / omega-3 ratio.
The western diet contains about 20 times more omega-6 fats compared to omega-3 fats, while ideally this ratio should be about two times.
We recommend consuming much more anti-inflammatory, heart-healthy omega-3 fatty acids, and much less omega-6 oils (which are mainly found in margarines, dressings, corn oil, canola oil, etc.).
We wrote more about the best ways to increase your omega-3 fat intake here.
17. Soy products
Soy products contain substances that can reduce the risk of heart disease (R).
Also, soy products like tofu are a great substitute for red meat, which is unhealthy for the heart. Red meat also accelerates aging (learn more about meat and aging here).
18. Take high quality, low TOTOX omega-3 supplements
Omega-3 fats are very important for proper heart health. Unfortunately, most people consume too little omega-3.
The best way to consume more omega-3 fats is by eating at least 4 times per week fatty fish, and by also regularly consuming fish roe (eggs of fish which are full with omega-3 oils, including the rare lysophosphatidylcholine-omega-3s).
However, on top of regular fish consumption, we recommend taking an omega-3 supplement, consisting of at least 1500 mg of omega-3 fatty acids.
We explain more about the best omega-3 fatty acids supplements here.
19. Green tea, white tea and coffee
Green and white teas contain many substances that impact your arteries in a beneficial way.
People consuming 3 or more cups of green or black tea had a 21 percent lower risk of stroke than people consuming less than 1 cup per day (R).
This was the conclusion of a large meta-analysis that looked in data from 9 studies involving 195,000 people.
According to another study, drinking 6 or more cups of tea per day was associated with a 36% lower risk of heart disease compared to people who only drank one cup or less per day (R).
Green and black teas contain EGCG and other substances that can slow down atherosclerosis.
Green tea is even more healthy than black tea, given it’s less oxidized. And white tea is possibly even better than green tea, given that it is even less oxidized.
Add lemon to your black, green or white tea to reduce the oxidation and increase absorption of the healthy ingredients in green tea.
Men consuming at least 3 cups of coffee a day had more than 50% less risk of stroke according to a large study (R). However, we advise consuming a maximum of 5 cups of coffee per day.
Make sure you don’t drink too much tea or coffee too late in the day, given they can disturb sleep. Ideally, you have your last cup of coffee in the early afternoon.
Not a lot of people (and even doctors) know that iodine is important for healthy blood vessels.
Studies showed that mice put on diets deficient in iodine have massive atherosclerosis. Iodine deficiency in humans is associated with an increased cardiovascular risk. Unfortunately, most people are iodine deficient – despite consuming iodized salt (hint: the iodine evaporates, processed foods don’t contain iodized salt and many people now consume sea salt) and having normal TSH levels according to their blood test.
Also, the official recommended iodine intake is also too low; ideally the amount of iodine intake is multiple times higher.
We explain more about iodine and optimal health here.
Many people, especially being 40 years or older, have a fatty liver.
A fatty liver is caused by too much deposition of fat in the liver. This is very unhealthy, leading to increased cholesterol levels, increased triglyceride (fat) levels in the blood and insulin resistance (including type 2 diabetes).
A fatty liver is associated with a significantly increased risk of heart attacks, strokes and Alzheimer’s disease.
In short, a fatty liver is a ticking time bomb, causing multiple metabolic and cardiovascular problems.
In fact, early research into choline (supplied by phosphatidylcholine) found that choline-deficient diets would induce fatty liver in otherwise healthy animals, despite how healthy the remainder of their diet was.
Phosphatidylcholine is also very healthy for the blood vessels and the brain.
22. NMN (nicotinamide mononucleotide)
Interestingly, NMN can also improve the health of the blood vessels.
For example, NMN can significantly improve the elasticity of blood vessels and blood flow. It also improves endothelial health (the endothelium is the thin layer that lines the blood vessels) (R,R,R,R).
23. Red yeast rice
Red yeast rice is a supplement extracted from rice that has been fermented with a yeast called Monascus purpureus.
Red yeast rice extract has shown to be able to reduce cholesterol levels (R).
Red yeast rice extract contains a substance, monacolin K, which is chemically identical to a statin (lovastatin), a standard drug to lower cholesterol.
So red yeast rice can be considered as both a supplement and a drug.
However, we should exercise some caution because this extract contains various other substances besides monacolin K, many of which we don’t know the long-term effects of yet.
24. Be picky about which statin you take
Mostly, when you have high cholesterol levels a statin is prescribed.
Statins inhibit an enzyme needed in the body for cholesterol synthesis.
However, much more important to reduce your risk of a heart attack are doing the things we described above, such as following a healthy diet, taking the right supplements and exercising.
If you do take a statin, we would opt for simvastatin, given this was the only statin that has been shown to also extend lifespan in mice.
Learn more about our Longevity Diet here (and download our poster for free).
Found out about the best supplements of anti-aging here.