When it comes to cholesterol, it is helpful to know that “lipids” is the medical term for your HDL, LDL, VLDL, non HDL, and triglycerides.  Though simplistic, LDL is referred to as the bad cholesterol and HDL the good cholesterol. The reason for this is that cells have a receptor for LDL that allows the cholesterol particles to go in and HDL has receptor that pulls cholesterol away. This is called reverse cholesterol transport and it is important for arterial health.
It is increasingly common to see humans with the metabolic syndrome of poor cholesterol numbers. It is mainly because of a lack of exercise coupled with too many carbohydrates. This is characterized by low HDL and high triglycerides and blood sugar is often mildly elevated. The metabolic syndrome is also referred to as prediabetes. This condition increases plaque buildup in the arteries among other things.
In this post I share my advice on how to improve your cholesterol levels without medication.
How Diet and Exercise Affect Cholesterol
A diet excessive in carbohydrates (starches and sugars) puts strain on your glucose regulation system. If you are not burning carbs then you are turning them into triglycerides and fat. The more a person exercises means the more carbohydrates they can tolerate. There are two reasons for this: one is because carbohydrates are burned, and secondarily the sensitivity to insulin is improved so it only takes a little insulin to clear the carbs out of your system.
The main source of starch in the diet is anything made from grains and potatoes. Think of sugars as anything that is sweet regardless whether it is a “healthy food” or not. You can track your carbs on various apps. A low-carb diet is 30g or below, and moderately low is 50g or below. You do not need to go to ketogenic. I am not against the ketogenic diet but have found that patients can’t stick with it, which creates a yoyo effect on labs and saturated fat intake increases, and cholesterol can get worse. I also get concerned about the lack of fiber in a ketogenic diet.
Aerobic exercise does modify lipids and therefore improve cholesterol levels. The changes you can expect by either starting or increasing your aerobic exercise are a decrease in LDL, an increase in HDL, and a decrease in triglycerides. If you have had the cholesterol particle size test performed, you can expect improvements there too with a decrease in small particles and an increase in big particles. If your heart is healthy more exercise is better. Mixing a little high intensity into the workout is always a good idea. I like to keep that simple with one minute on, one minute off, or two minutes on and two minutes off for three sets.
An easy way to increase exercise is just do more of what you already like. If you are a walker, you can walk more; hopefully adding some hill work. If you are a cyclist, swimmer, or runner just increase that activity. Any increase in your exercise is going to show improvement on your cholesterol labs.
Strength training can be helpful too if you keep your heart rate up throughout your workout. Doing a warmup on one of the machines is helpful and you can add high intensity to this.
Whole Foods Plant Based Diet
I recommend that people follow either a complete or partial whole foods plant based (WFPB) diet as your default diet. This diet has the best scientific support for preventing heart attacks, cancer, and stroke, and works to reverse arterial plaque. Other diets such as Paleo or ketogenic do not have the same scientific support but a completely animal free diet is not for everyone. If you are eating animal products make sure you consume substantial amounts of fruits, vegetables and leafy greens along with them. For instance, to counteract the negative effects of eggs add raw spinach, arugula, tomatoes, and steamed broccoli to your scrambled eggs.
Foods That Improve Lipids
The lower cholesterol levels seen in the Japanese population are due to the increased soy in their diet.  Soy contains isoflavones that have been definitively proven to lower bad cholesterol. The best source are whole soybeans (such as edamame) or Tempe. Soy protein powder, soy milk, and tofu are also good but are more processed. Any concerns about disruption of hormone levels are unfounded. It has not been shown to affect male testosterone levels.
In women who eat soy, I have seen an improvement in menstrual problems and a decreased risk of hormone sensitive cancers such as breast and uterine. The phytoestrogens found in soy products have very little molecular similarity with actual estrogen, but they do bind to estrogen receptors and modulate the effects of estrogen. They are known as SERMs (selective estrogen receptor modulators). Eating 25 grams of soy protein a day (10 ounces of tofu or 2 1/2 cups of soy milk) can lower LDL by 5% to 6%.
Soluble Fiber Helps Move Cholesterol Out
The main sources of fiber in the diet are fruits, vegetables, nuts, and seeds. Animal foods do not contain any fiber. Soluble fiber is especially good at binding to cholesterol so that it can be excreted. Good examples here are oatmeal, ground flaxseed, Chia seed, and all beans. All fruits and vegetables contain some soluble fiber. Insoluble fiber is the type that cannot be digested and that is also helpful.
Raw nuts such as Brazil nuts, cashews, and almonds can also improve cholesterol levels.
Drinking two to three cups of green or black tea a day has been shown to improve HDL, LDL, and triglycerides.
What Not to Eat When Watching Your Cholesterol
The following is my “do not do” list.
Eliminate animal fat, saturated fat like coconut, palm oil, cheap cooking oil (such as corn, cottonseed, and canola) and trans fats from your diet as much as you can. Olive oil and avocado oil are the preferred oils to use. Use avocado oil for anything other than very low heat cooking. Other than flaxseed oil I do not like my patients to eat seed oil. Oils should always be organic and cold pressed.
Completely cut out hydrogenated or partially hydrogenated vegetable oils. These are found in certain brands of peanut butter, store-bought cookies, and supermarket baked goods. Deep-fried food really should be avoided as well. One exception is if you prepare fried food at home carefully using avocado oil.
Never buy nut butters with added palm oil, hydrogenated oils, or sugar. Do not eat any food with added palm oil. Palmitic acid creates arterial inflammation.
I sometimes ask patients to limit egg consumption. Eggs are nutritious but super concentrated in cholesterol and, in some patients, this is too much. Eggs are a smart choice for children and teenagers as well as young adults. As we age and start getting arterial disease and high cholesterol they need to be scaled back. I know there is a controversy about dietary cholesterol and eggs but I can tell you that typically the more cholesterol person eats the higher the blood level goes. An interesting fact is that all humans do not absorb cholesterol from the diet equally. This is likely the reason for conflicting data on cholesterol levels and eggs.
Supplements, Plant Medicine, and Nutraceuticals for Improving Cholesterol
Red yeast rice has compounds called monacolins that modify how the liver makes cholesterol. The first cholesterol drug was modeled after this. Red yeast rice has been used for thousands of years for circulatory disorders. It has been found to be effective and safe for cholesterol and well tolerated with less side effects than prescription cholesterol drugs. Its main action is to lower the bad cholesterol although some improvements in triglycerides and HDL may also be seen.
Time-released niacin (B3). High doses of this vitamin act like a cholesterol drug. I typically prescribe between 500 mg to 1,500 mg. It has four main actions: it lowers triglycerides, raises good cholesterol, lowers bad cholesterol, and increases the cholesterol particle size. There is no other prescription drug that does all these things. The side effects from niacin are based on dose. Do not take more than 500 mg unless you are under medical supervision.
Coenzyme Q 10 (QPro) helps with blood pressure, cognitive function, heart function, and is a great antioxidant. It needs to be taken if you are on red yeast rice.
Resveratrol (resveratrin) is concentrated red wine extract that can lower cholesterol and blood pressure as well as change the expression of certain genes. It protects your arteries and is a potent vascular antioxidant.
Aged garlic extract can help with blood pressure and cholesterol.
Green tea extract can help with cholesterol levels.
Highly concentrated pomegranate extract can greatly improve large artery health. It works by super charging the ability of HDL to remove cholesterol from the artery wall. I have been using this for over 15 years with particularly good results.
Fish oil makes the blood thinner, may lower blood pressure, and is anti-inflammatory. Contrary to widespread belief, it does not work very well for cholesterol but can lower triglycerides nicely. Pro tip: if your triglycerides are high and you lower them your LDL may in turn go up. This is because triglycerides mask LDL measurement. The laboratory equipment that measures lipids can get confused by the triglycerides. The result is an LDL that is better than it really is which is then unmasked as triglycerides go down.
Bergamot (Bergacor) extract can lower blood sugar and improve cholesterol levels. I’ve had mixed results with this.
Berberine can improve cholesterol levels and lower blood sugar.
Vitamin K2 can reduce calcified plaque and make the arteries more flexible.
Vitamin D helps with blood pressure, reducing all causes of death, improves mood, and reduces risk of heart attacks. Three fifths of all patients I test in the front range are deficient.
Ground flaxseed can be effective for both blood pressure and cholesterol. I recommend two tablespoons per day.
Various fiber powders can be effective.
Plant sterols, also known as phytosterols, block the reabsorption of cholesterol from the intestinal track thereby lowering blood levels.
Black cumin seed oil is one of the newer things I am using.
If you would like to discuss ways to improve your cholesterol, contact our office to make an appointment with Dr. Steve Parcell: 303-884-7557.
 More sophisticated lipid panels include LDL particle number and cholesterol particle size.
 Chisato Nagata, Naoyoshi Takatsuka, Yoko Kurisu, Hiroyuki Shimizu, Decreased Serum Total Cholesterol Concentration Is Associated with High Intake of Soy Products in Japanese Men and Women, The Journal of Nutrition, Volume 128, Issue 2, February 1998, Pages 209–213,