Can you reduce your cholesterol without taking a drug?

That’s one question people ask their doctors: How to lower cholesterol? While many choose to stay off drugs, others, like a Heart reader who wrote to us recently, opt for cholesterol-lowering medications. He’s an active, lean 76-year-old man with a healthy heart (mostly organic fruits and vegetables, whole grains, and lean meats, but no red meat or alcohol). His blood pressure and blood sugar are normal, but his LDL (“bad”) cholesterol is 157 milligrams per deciliter (mg/dL), which is considered borderline high.

In general, there are three main ways to lower your LDL to the recommended 100 mg/dL or below: diet, medication, or medications such as statins. Here is Heart Letter Editor-in-Chief Dr. Christopher Cannon.

Dietary changes

Many people do not realize that only 20% of the cholesterol in the blood comes from food, with the rest produced by the liver and intestines. For most people, dietary cholesterol is not a major concern. However, most of the cholesterol in the average person’s diet comes from animal products, such as meat and dairy products, which also contain saturated fat. Saturated fat raises LDL cholesterol levels, so consumption should be limited.

The rest of your diet is very important. Replace saturated fats with unsaturated fats (such as those found in vegetable oil, avocado, and oily fish). Eating foods high in fiber (such as vegetables, fruits, legumes, and whole grains, especially oats) can help lower cholesterol by reducing the amount of hard-to-digest cholesterol absorbed from the intestines.

If you eat cheeseburgers and ice cream regularly and then gradually switch to a healthier diet, you will notice your LDL levels drop. If your diet is already healthy (like the reader described above), making further changes will not make a difference. “I often tell patients that some people see a decrease in their LDL levels after changing their diet, while others don’t,” Dr. Cannon said. But he added that even if your LDL doesn’t drop much, there are other heart benefits to good nutrition. For example, many compounds found in whole, unprocessed foods help reduce inflammation and stop plaque buildup.

Supplements

Many foods sold in the United States claim to be heart-healthy. But only three things can help lower LDL cholesterol, not many.

Psyllium husks. Derived from the seeds of the egg-shaped plantain plant, this fiber supplement is best known for treating constipation (Metamucil is a well-known brand). Mix the powder with liquid to form a thick gel. Psyllium husks or powder are also available in wafers, bars, and tablets. It works to absorb bile acids and cholesterol that are released from the body during digestion. The recommended daily intake is 5 to 10 grams. A review article published in April 2024 in the journal Health found that taking psyllium daily for one or two months can reduce LDL by an average of 6 percent.

Phytosterols. Also known as phytosterols, these compounds are found in the cell membranes of plants such as olives, soybeans, peas, and rapeseed (a source of rapeseed oil) and have a structure similar to cholesterol. Eating them helps reduce the cholesterol your body absorbs. Manufacturers offer many foods with added plant sterols, including margarine (such as Benecol), mayonnaise, bread, breakfast and snack foods, milk, and fruit juice. Plant sterols are also available in capsule form. Some research suggests that taking 2 grams of plant sterols daily for at least eight weeks may reduce LDL by up to 10 percent. However, a recent, well-controlled 4-week study (the Supplement, Placebo, or Rosuvastatin Trial, or SPORT) found that plant sterols lowered LDL by 4.4 percent.