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High cholesterol: Lowering cholesterol without tablets

Created: ; Last Update: September 7, 2017; Next update: 2020.

High cholesterol levels could mean an increased risk of cardiovascular disease. People who would like to lower their risk don't necessarily have to take medication. General measures like changing your diet can also have a beneficial effect and improve your heart health.

The treatment of high cholesterol focuses more on reducing the risk of cardiovascular disease over the long term rather than on lowering cholesterol levels.

Many people who want to do something about their high cholesterol levels would rather not take medication. Various general measures are recommended for the prevention of cardiovascular disease, although they don't necessarily lower cholesterol. They include the following:

  • Not smoking
  • Reducing the amount of saturated fats in your diet
  • Getting a lot of exercise
  • Losing weight

Not smoking

Quitting smoking lowers your risk of cardiovascular disease and generally increases your life expectancy – regardless of how high your cholesterol levels are. So it's definitely worth kicking the habit, even if doing so hardly affects your cholesterol levels.

Diet and weight

There is plenty of dietary advice out there for people with high cholesterol (hypercholesterolemia). But only very few recommendations are based on high-quality scientific research. A number of studies suggest that reducing the amount of saturated fats in your diet can lower your risk of cardiovascular disease. This doesn’t mean you have to eat a low-fat diet. The main thing is to try to replace saturated fats with unsaturated fats. In other words, eat more vegetable oils and fish, and less meat and high-fat dairy products. In studies on the effects of dietary changes, weight loss didn’t influence the likelihood of developing cardiovascular disease.

According to current research, eating a Mediterranean diet can help lower various risk factors for cardiovascular disease, including cholesterol levels. This sort of diet mainly includes a lot of vegetables, fruits, legumes, nuts, olive oil, whole grain products, fish and poultry.

Exercise

Experts generally assume that regular exercise can prevent cardiovascular disease. But this has not been proven in high-quality studies. And there are also no high-quality studies on the effect of physical activity on cholesterol levels.

In no way does this mean that people with high cholesterol won't benefit from getting more exercise, though. Regular exercise is known to have a positive effect on other risk factors for cardiovascular disease as well.

Special foods

For a number of years now there have been special kinds of margarine spreads that are claimed to have a cholesterol-lowering effect. They contain substances that can inhibit the absorption of cholesterol, known as phytosterols. It's not clear whether these kinds of margarine spreads can improve your health.

Other types of foods are also sometimes claimed to have a cholesterol-lowering effect. The main ones include artichoke extracts, fish oil, garlic, guggul, policosanol (a sugar cane extract), red yeast rice powder, soya, walnuts, products containing soluble fiber (such as psyllium) and green tea extracts (catechins). Many of these products are sold as highly concentrated dietary supplements in the form of capsules. But none of them have been shown to prevent health problems associated with high cholesterol.

Most of these products haven't even been clearly proven to lower cholesterol levels. Products with green tea catechins in them are the only products that this has been studied in. They were found to slightly reduce cholesterol levels in people who have high cholesterol. In the studies, total cholesterol dropped by about 6 mg/dL and LDL cholesterol dropped by about 4 mg/dL on average. But this doesn’t necessarily mean that green tea catechins improve your health – for instance, by preventing heart attacks. And the studies were too short to be able to draw any conclusions about the long-term effects of these products.

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© IQWiG (Institute for Quality and Efficiency in Health Care)
Bookshelf ID: NBK279316

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