Dr. Day is a cardiologist and Medical Director of Heart Rhythm Services at his practice in Salt Lake City, Utah. He graduated from Johns Hopkins Medical School and completed his residency and fellowship in cardiology at Stanford University. He is board certified in Cardiology and Cardiac Electrophysiology.
3 Ways to Lower Cholesterol: Better than Drugs
Cholesterol is just one of many risk factors for heart disease. Fortunately, there are better ways to lower cholesterol. In this article, I share the three best ways to lower cholesterol naturally.
My Bad Cholesterol Gene
I was not born with the low cholesterol gene. Even worse, I inherited one copy of the ApoE4 gene. Sadly, one in four Americans also have at least one copy of this ApoE4 gene as well.
The ApoE4 gene not only controls cholesterol levels but is also the Alzheimer’s Disease gene. Thus, people with this gene are at high risk for an elevated cholesterol and Alzheimer’s Disease.
Thus, it should come as no surprise that when I was on a sugar, processed foods, meat, and dairy diet, my cholesterol was high. In fact, at one point my total cholesterol was 211 mg/dL.
My First Attempt to Lower Cholesterol
As a cardiologist, I knew I had to lower cholesterol. Not wanting to make any changes to my lifestyle, I put myself on the most popular statin drug, atorvastatin (Lipitor).
Within a week or two of starting this drug, I tore my gastrocnemius muscle (calf muscle) while playing basketball. While it could have been a “coincidence,” it didn’t seem like one to me.
Fearing it was a side effect of the drug, I immediately stopped atorvastatin. I reasoned that it was better to risk a heart attack than give up playing basketball. Interestingly, the only muscle tear in my life was during the one to two weeks I was on atorvastatin.
How I Dropped My Total Cholesterol from 211 to 118
For the next seven to eight years, I basically just ignored my cholesterol. I knew it was high but didn’t want to think about it.
As part of my health turn around a few years ago, processed foods, sugar, and dairy were all but eliminated. Other than an occasional wild fish, everything had to be real food high in fiber.
It was basically the ultra high fiber version of the traditional Mediterranean Diet. Almost immediately, my cholesterol dropped. Without even a single medicine, it went from 211 to 118.
Lifestyle vs. Genes
While we all have “bad genes,” fortunately lifestyle trumps genes. Indeed, studies show that only about 20% of our health, happiness, and longevity is determined by our genes. The other 80% is entirely from the little health decisions you make every day.
The Nigerian Paradox
This finding that lifestyle beats out genes could explain the Nigerian Paradox. The Nigerians are known to have the highest rates of the ApoE4 gene but yet also have very low cholesterol.
How can this be?
The answer comes from their lifestyle. At the time of this study in 1989, the Nigerians were still physically active and ate a mostly plant-based real food diet. Interestingly, studies show that not only was their cholesterol low but heart disease and Alzheimer’s Disease were also incredibly rare.
Studies show that even in nearby Uganda, heart disease is virtually nonexistent. To prove this, researchers had to autopsy the hearts of 1,427 older adults, to even find one person with a mild case of heart disease.
Sadly, once Africans with the ApoE4 gene emigrate to the U.S., and adopt a Western lifestyle, everything changes. Their cholesterol shoots up and heart disease and Alzheimer’s Disease soon follow.
The Confusion About Cholesterol
While there is a lot of confusion on the Internet about cholesterol, if you look at the scientific literature there is no confusion. Cholesterol is an important risk factor for heart disease.
However, not every heart attack comes from a cholesterol plaque. Cholesterol is just one of many risk factors for heart disease.
For example, your cholesterol naturally drops when you are sick. If you measured cholesterol levels in ICU (intensive care unit) patients, you would see very low numbers. Despite this, ICU patients are at high risk of a heart attack while in the ICU.
Even something as simple as a respiratory tract infection or a urinary tract infection can significantly increase your risk of heart attack. Studies show that even losing an hour of sleep, like what happens every year with daylight savings time in the U.S., can trigger a heart attack.
Basically, anytime your body is under stress, regardless of your cholesterol level, you are at risk of a heart attack.
Will low cholesterol protect you from heart disease?
Studies show that Chinese or Africans with a traditional lifestyle (plant-based real food with high levels of physical activity), tend to have a total cholesterol naturally below 150 mg/dL. Studies also show that these people don’t get heart disease.
Does their low cholesterol protect them from heart disease? Or is their healthy lifestyle?
I suspect both are true. Of course, once they emigrate to the U.S., and adopt a Western lifestyle, their risk is no different than anyone else.
3 Ways to Lower Cholesterol: Better than Drugs
Based on medical science, here are my three best natural ways to lower cholesterol. All three have been proven to work better than the “statin” cholesterol lowering drugs.
1. Mediterranean Diet
Contrary to popular belief, the Mediterranean Diet is not an all you can eat pizza and pasta diet. Rather, the traditional Mediterranean Diet is a plant-based real food diet with some fish. In other words, you eat mostly vegetables, fruits, nuts, olive oil, legumes, and real whole grains.
How well does the traditional Mediterranean Diet work to lower cholesterol?
While the Mediterranean Diet may not lower cholesterol as much as a statin drug, it may be better at preventing heart disease. Indeed, a recent study showed that even in people with heart disease, the Mediterranean Diet was more protective than statins.
2. Ultra High Fiber Diet
Do you want to know the real secret to lower cholesterol? Eat more fiber.
Even though the U.S. government only recommends a mere 14 grams of fiber for every 1,000 calories you eat (28 grams of fiber daily based on a 2,000 calorie diet), the typical American can only get about 15 grams. These 15 grams are a far cry from the 100+ grams of fiber that studies show our hunter-gatherer ancestors used to eat each day.
A few years ago, researchers wanted to know what would happen to cholesterol levels if you ate 100+ grams of fiber each day. For two weeks, study volunteers ate more than 100 grams of fiber each day. Fiber supplements were not allowed.
After just two weeks, they dropped their LDL, or bad cholesterol, by 33%. This is more than what you see with statin cholesterol lowering drugs.
Even more impressive, other studies have shown that for every 7 more grams of fiber you can eat daily, you can drop your heart disease risk by 9%. If this study hold true, then eating 100 or more grams of fiber each day essentially eliminates your risk of heart disease.
While I shoot for 100 grams of fiber each day from real food, I’m still not there. For the last year, my daily average was only 86.71 grams. If you want to track your own fiber intake, there great apps like Healthwatch 360, My Fitness Pal, Lose It to help you.
It goes without saying that you can’t prevent heart disease with fiber supplements. You have to eat real food. If you are not used to eating fiber, talk to your doctor first. It may take time for your gut to get used to digesting fiber.
3. High Levels of Physical Activity
As with the Mediterranean Diet, exercise does so much more than lower cholesterol. For example, exercise moves LDL out of your arteries into your liver.
Also, like with the Mediterranean Diet, exercise changes the structure of cholesterol. Rather than the small and dense forms of LDL, which can lodge in an artery, exercise changes it to the benign big and fluffy forms.
Finally, as with the Mediterranean Diet, studies show that exercise lowers your bad cholesterol by around 10%. However, when it comes to preventing heart disease deaths, exercise beats statin drugs.
For example, in one study, Stanford University researchers compared the effects of exercise versus statins in preventing premature death. As part of this study, researchers recruited 10,043 middle-aged veterans with high cholesterol.
After following these veterans for 10 years, researchers found that the physically fit veterans with high cholesterol were 47% less likely to die prematurely. In contrast, veterans just taking statins were only 33% less likely to die prematurely.
How physically do you have to be? In order to drop your risk of dying prematurely by 47%, you had to be fit enough to sustain a 9 MET (metabolic equivalent) workout.
Exercise above the 9 MET level includes running (not jogging), aggressive swimming, a boot camp or CrossFit class at the gym, bicycling up mountains, or competitive soccer/basketball. Of course, if you are not used to exercising at this level, speak with your doctor first.
Take Home Message
The main take away is that a healthy lifestyle not only keeps your cholesterol low but also protects you against heart disease.
If you are on a statin cholesterol lowering drug, do not stop your medication. Also, if you already have heart disease, you will probably be on a statin for life.
However, if the statin is for ‘prevention,” then work with your doctor to lower your cholesterol naturally. If you can get it low naturally then the statin will no longer be needed.
Do you have high cholesterol? How have you lowered your cholesterol?
Disclaimer Policy: This website is intended to give general information and does not provide medical advice. This website does not create a doctor-patient relationship between you and Dr. John Day. If you have a medical problem, immediately contact your healthcare provider. Information on this website is not intended to diagnose or treat any condition. Dr. John Day is not responsible for any losses, damages or claims that may result from your medical decisions.