Lower cholesterol doesn’t have to come from a pill.
Although cholesterol drugs are in the news lately, what is getting lost in the discussion is the fact that it’s possible to lower your cholesterol without drugs. It’s just not as easy.
In fact, many doctors think dietary changes are too difficult for most of their patients. While they typically encourage better eating and a diet low in saturated fat, they also prescribe cholesterol-lowering drugs called statins as a faster way to lower bad cholesterol.
But many people can’t tolerate statins and their side effects. Others simply don’t want to take a pill every day or shoulder the cost of a prescription. For those patients, dietary changes may be a better option.
In 2006, The American Journal of Clinical Nutrition reported on a study of 55 patients with high cholesterol who, over the course of a year, started eating a diet rich in soy proteins, fiber and almonds. All those foods may have cholesterol-lowering properties. Twenty-one patients managed to lower their cholesterol by 20 percent or more by the end of the year. The researchers noted that whether the patient was motivated and actually stuck with the diet most of the time was key.
Journalist Tom Burton, a former colleague, wrote about his own efforts to lower cholesterol without drugs for The Wall Street Journal. He found that many doctors don’t really know how to advise patients about dietary changes to lower cholesterol. He found one who did and used him as a nutrition “coach” to help him figure out which changes would be most effective for him.
The problem for Mr. Burton was that he already had a pretty healthful diet. He ran four miles most days and had given up red meat and most cheese. But his bad cholesterol was 169 mg/dL — far above the 100 mg/dL most doctors recommend. Doctors were telling him statin drugs were in his future.
After documenting his eating habits, Mr. Burton was advised by his doctor to cut out a favorite dish — roast chicken with the skin on. He was told that more of his protein should come from fish, beans and nuts. He phased out the chicken as well as shrimp and squid, which are high in dietary cholesterol. He began including steel-cut oatmeal, eggplant, roasted soybeans, whole-wheat pasta and Brussels sprouts in his diet. He also increased his exercise. His cholesterol numbers were slow to move, but eventually they did, dropping 33 percent.
To read Mr. Burton’s story, click here. Even better, the story includes a link to two favorite recipes from his cholesterol-lowering diet. (If you don’t have a Wall Street Journal subscription, you can read the story for free here.)
But Mr. Burton’s success doesn’t mean it’s easy. Last fall, my colleague Jane Brody documented her own struggle to lower cholesterol by diet alone. Few people can claim a diet as healthful as Ms. Brody’s. She eats well and exercises regularly, putting the rest of us to shame. Still, her cholesterol kept creeping up. After a concerted effort to lower her numbers with dietary changes, she finally relented and took a statin. To see her full story, click here.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 81 Comments
My doctor says the best way to control your cholesterol is to choose your Grandparents.
— FrancesI would like to read Mr. Burton’s article, but the link required a paid subscription. Access to that article would be appreciated by those of us with the same challenge of high cholesterol.
— PennyFrom TPP — I didn’t realize it was subscription only. I found a free link and added it to the story.
Dad dramatically lowered his bad cholesterol. Breakfast : 1 cup cooked oat bran with soy milk. Lunch: 1 cup cooked oatmeal w/soy milk and 1/3 can of salmon. Supper raw fruits and veggys. Snacks : raw carrots and broccoli.
— dale moodyWhen you loose all the weight you want and get your cholesterol numbers right : you can start eating a light “real” meal for supper.
When dad started , this was his diet 7 days a week.(+ exersise !)
“Journalist Tom Burton, a former colleague, wrote about his own efforts to lower cholesterol without drugs for the Wall Street Journal. He found that many doctors don’t really know how to advise patients about dietary changes to lower cholesterol.”
I read his article. Burton provides no support for the contention that many doctors don’t know.
The reality is that this is usually handled by referral to a nutritionist, since such counseling takes a lot of time.
What is not mentioned in these articles is that many patients decline the referral. Of those who don’t, many are not compliant. Of those who are compliant, many cannot get their cholesterol sufficiently low.
Most competent docs, unless there is imminent high risk of a cardiovascular event, give the patient 6 months to reach the goal with diet, exercise, supplements, etc, and then recommend usually a statin.
— jackit is often NOT reported that many people have high cholesterol because our bodies make too much and diet won’t help that. i was on a cholesterol lowering diet for years and then went on a really strick diet and my cholesterol level never changed. i still eat a plant based diet and don’t think about my cholestrol much. i’m 67 and male so i have 3 risk factors and healthy, buy i don’t want to take the statin drugs. yet.
— organicthe high cholesterol levels run in my family.
No study, to date, has proven a direct link between cholesterol and heart attacks/disease. Mostly statins manufacturing pharmaceurical companies with the help of bought (with money from those companies) scientists and physicians namely (Scot Grundy and other members of the advisory committe excluding two)are responsible for propagating the myth that cholesterol is a risk factor for heart disease. Only study that is there is that after the first heart attack if the patient is given statins(Lipitor, Zocor, Pravachol, Mevachol, etc Zetia and Vytorin did not exist then) the next episode was delayed as compared to the placebo group.
— Pawan BaliDon’t forget that hypothyroidism can cause LDL levels to increase. Be sure to check thyroid function when investigating seemingly mysterious rises in cholesterol.
— BeatriceMany people think that Americans are always looking for the quick fix, which is why we would rather pop pills to lose weight or control blood pressure than change our life styles. But as your comments (and those of Ms. Brody and Mr. Burton) point out, lifestyle changes aren’t always enough.
Why is it that medical advice has to be so dichotomous: either change your lifestyle OR take this pill? Doctors and other health care practitioners should engage their patients on all levels to assess their motivation for change and their possible acceptance of pharmacological therapies. Chronic illness of all types may need to be controlled with diet, exercise, other lifestyle choices, AND drugs. And what works for one person may not work for you, so you need to work with your health care team to figure out what does work for you.
And on a separate note, kudos to Mr. Burton for seeking out a physician that pushed food and nutrition (And kudos to his physician, Dr. La Puma). Nutrition is not really taught in medical schools, so most physicians think they counseling their patients on nutrition when they say “follow the food pyramid” or “eat more fiber”. While not necessarily wrong, these comments leave the “how do I do THAT?” out of the equation. If your doctor is giving you that “how to” information, either find a new doctor or ask for a referral to a nutritionist/dietitian who can help.
— WSI’m betting that this comment section will be a combination of people saying, “I made diet changes and lowered my cholesterol so no one needs statins,” people saying, “I have high cholesterol no matter what I eat, so diet doesn’t really matter and people shouldn’t criticise statins,” and a really high proportion of ‘Internet Doctors’ talking about patient ignorance and why they prescribe the medications they do.
Maybe the answer is:
Diet works. For some people. Others, statins.
— RowanI implore the journalistic community to take a cold hard look at the history of the lipid hypothesis,the research regarding statins in general, and the money trail (boulevard?). Start with the work of Uffe Ravnskov in Sweden and Malcolm Kendrick in the UK. It’s just a matter of which journalist gets this huge story first.
— Nicholas CastellucciLowering your cholesterol through diet doesn’t have to be tough at all — in fact it can be highly pleasurable. Over 50 years of meticulously conducted research has shown that following traditional Mediterranean or Asian eating practices is one of the most effective ways of lowering cholesterol and reducing the risk of heart disease. But the best part is that the cuisines of the Mediterranean and Asia (including Italian, Greek, Provencal, Spanish, Japanese, Chinese and Vietnamese) are some of the most appetizing cuisines in the world.
And as a bonus, traditional Mediterranean and Asian eating practices are also associated with long life spans and low rates of obesity, type 2 diabetes, cancers of the breast, prostate and colon, and Alzheimer’s disease.
For more info: http://www.mediterrasian.com
— TrudyEat oatmeal! I have only anecdotal evidence but 3 out of 3 people who I recommended to eat oatmeal for breakfast saw a drop in their LDL without other lifestyle changes. I also had the same result. Put a banana in there and some walnuts or peanut butter for a delicious meal! Yum!
— AnneI agree that we tend to underestimate the effects of diet modification and that we sometimes underestimate the patient’s ability to make drastic changes. Same thing happens with smoking cessation.
One important point about statins is the following. These drugs have two mayor effects: One is LDL lowering, but also an anti-inflammatory effect that is believed to stabilize coronary plaques. If I am taking care of a patient who has a history of coronary disease (previous heart attack, for example)or if he/she is a high risk patient (diabetes, multiple risk factors, high Framingham Risk Score)and I am assuming that there is underlying coronary disease, I am more quick to use statins due to this anti-inflammatory / stabilizing plaque effect. I believe that I am offering the patient a greater degree of protection against future events. I would obviously try to encourage the patient to follow a heart healthy diet at the same time. Some experts may argue that certain diets exert similar anti-inflammatory effects.
I believe that the issue with physicians and diet counseling is one that is heavily affected by time constraints. We just don’t emphasize preventive medicine enough (unfortunately, probably because it doesn’t pay to do it).
Juan J. Rivera
— Juan RiveraAlternatively, you and Jane Brody could look at the growing mountain of evidence that the diet you think is “healthful” is actually the problem…evidence which includes Brody’s own health!
Or you could read the most important book on diet in the last century, “Good Calories, Bad Calories” by Gary Taubes.
But you won’t; you’ll keep passing out the same old misinformation.
Nor will you publish this comment.
From TPP — Of course i will publish your comment, and I think your point, if you strip away the personal attacks, is a good one. Nutrition writers like myself certainly have been complicit in confusing people’s notions about what constitutes healthful eating. (Although I’m curious about what I’ve written that offends you so.) I’m not sure I agree that Gary Taubes has written the most important book on diet (I’m a fan of Pollan as readers of this blog know). However, Mr. Taubes has certainly raised many important issues in his work. I agree, as Mr Pollan writes, that the culture of nutritionism — viewing food as a sum of its nutrient parts — has been largely detrimental to the nation’s health.
— TomHave you read Taubes’ book? Or just read about it?
From TPP — I find the loyalty that Mr. Taubes inspires quite fascinating. I think I have probably read every news or magazine story Mr. Taubes has written, at least in the past 8 years. I have not finished his book, although I have read much of it. So yes, I am personally quite familiar with his work — I haven’t just read the reviews. As I said earlier, i think he has made an important contribution to the discussion, but I don’t always agree with him.
— TomWhy bother trying to lower serun LDL with diet? There’s no reliable evidence that doing so will accomplish anything worthwhile.
Read what Gary Taubes has to say about this. He cites data from published studies that have estimated how much, on average, a healthy person can, in theory, expect to extend his life expectancy through aggressive dietary modification aimed at lowering LDL. The estimates he found were all on the order of a few months. What’s more, the validity of these estimates is dubious, as they are necessarily based on one of two faulty data sources, namely statistical correlations between serum cholesterol levels and cardiovascular disease (as opposed to experimental results) or else experimental data from statin trials (as opposed to diet modification trials). One must keep in mind that, to date, no large, well-controlled, randomized feeding trial of dietary LDL reduction has ever found a statistically significant benefit in terms of reduced cardiovascular disease or mortality; notably, four such studies that concluded just prior to the dawn of the statin era found low-fat, cholesterol-reducing diets useless in reducing the risk of heart disease.
The reams of data everyone assumes exist linking high serum LDL with increased cardiovascular disease don’t exist - unless you fraudulently hand-pick data supporting a connection as Ancel Keys did or interpret data from statin trials to apply to dietary LDL reduction.
There are dietary changes that show promise for reducing the risk of cardiovascular disease, type 2 diabetes, and cancer that are borne out by good science: eliminate dietary trans fats; cut down on carbohydrate consumption and glycemic load, especially if these appear to cause short satiety/hunger cycles, a tendancy toward obesity, or elevated levels of triglycerides or small/dense-particle LDL; consume oily fish often, and get a little alpha linolenic acid daily from flax, flax oil, or walnuts, but avoid consuming polyunsaturated-type vegetable oils (safflower, corn, soybean, flax, etc.) in quantity or cooking with them. Dietary reduction of aggregate LDL is not supported by sound science, and, unfortunately, the reductions in dietary saturated fat typical regimens call for shortchange the body of fat types that are nutritionally important for proper maintenance of the body’s cell membranes and production of vital hormones.
To make a long story short, the science behind conventional medical advice to reduce serum LDL by dietary intervention is a wobbly house of cards.
The site http://www.thincs.org links to a number of writings and presentations by Uffe Ravnskov, Malcolm Kendrick, Mary G. Enig, Barry Groves, and others that examine the diet-heart disease controversy in depth.
— Melton C. PresleyBy the way, Tara, it’s worth remembering that high cholesterol is NOT a disease. It’s a lab result.
Wouldn’t it be amazing if that lab result didn’t really have anything to do with mortality, except in men under 65 who have ALREADY HAD HEART ATTACKS?
http://www.proteinpower.com/drmike/statins/a-bad-week-for-statins/
From the upcoming Business Week cover story on cholesterol & statins: (Ignoring the question of why Business Week is beating the NYT on health news.)
“What if you put 250 people in a room and told them they would each pay $1,000 a year for a drug they would have to take every day, that many would get diarrhea and muscle pain, and that 249 would have no benefit? And that they could do just as well by exercising? How many would take that?” asks drug industry critic Dr. Jerome R. Hoffman, professor of clinical medicine at the University of California at Los Angeles.”
— TomKudos to Tara for bringing this up. Medications aren’t required for healthy cholesterol levels. Take The China Study for example, rural Chinese eating a vegetable-based diet rarely develop heart disease or suffer heart attacks. A vegetable-based diet offers the best protection from all diseases, including heart disease, and, even cancer!
As for the comment by “Tom.” Tom, please stop spreading the low-carb nonsense and the agenda of Atkins devotee Gary Taubes. This type of information is of little scientific value and extremely misinformed and dangerous, especially to our very impressionable population.
I blogged about this on my own blog:
http://www.diseaseproof.com/archives/cholesterol-cholesterol-well-blog-encounters-a-loon.html
— Gerald PuglieseSomethings the key element of a diet is what one doesn’t eat. Is eating oatmeal truly beneficial or is it that by eating oatmeal one did not eat eggs and bacon for breakfast?
My doctor gave me six months to lower my cholestorol through weight loss and diet changes. He also sent me to a nutritionist. It has worked so far.
For those who cannot, or won’t, see a nutrtionist, you can also use the free online dietary diaries to track food and nutrition consumption.
— WJSI’m 41. I have high blood pressure controlled by an ARB (Avapro) which I take twice daily. My lipid profile is outstanding (Chol: 145; Trigs: 38; HDL-C: 64 on 1/2/08). I have never taken a cholesterol lowering drug. My weight, however, is normal; my body fat percentage is extremely low (single digit); and I am monastic about my diet and physical exercise regimen. Multiple studies have shown people as a rule are lousy historians when documenting the numbers of calories consumed each day. I suspect those who claim dietary failure with respect to controlling serum cholesterol are simply not rigorous enough in their approach.
— debaserWow, Gerald, I’m not going to engage you in your kettle-black slapstick, but I will refer interested readers to Seth Roberts interview with Taubes:
http://docs.google.com/View?docid=dhm4f3rg_36gg4956dm
— TomActually Burton’s results were the same as Brody’s, he couldn’t stay below the doctor prescribed “limits” on diet alone. The South Beach cardiologist is as equally persuasive as Taubes and he thinks we need to go on statins early and often. Sometimes you just have to use medicines whether you want to or not.
— RichNever feel too criticized for sharing topical information with us. We all have choices. Thank you.
— a readerI have a strong family history of high cholesterol (my dad had his first heart attack at 45 and no male member of our family has lived past the age of 70 due to coronary issues). My Dad is now approaching 70 and has been on statins since they first came out. He refuses to adjust his diet (much to my frustration), but the medication seems to be working very well to control his lipid levels.
Since I knew this would eventually be a problem for me, I decided to be proactive & started getting my own numbers checked. I was alarmed to have a total cholesterol reading of 210 at the age of 28. I assume that eventually I will have to go on statins, but I’d like to put it off for as long as possible, so I decided to make some changes to my diet. I wasn’t expecting it to work as well as it has… in 2 years, I’ve managed to lower my total cholesterol to 150 (28%) by making some changes. These were not radical changes for me, and I’m not puritanical about them even now, but they’ve made a big difference.
Things I’ve eliminated:
- All red meat & pork except for very special occasions (and when I do indulge, I only eat pasture-raised/organic varieties)
- Trans fats… this requires scrutinizing package labels & eliminating almost all processed foods
- Butter… In all cooking recipes calling for butter, I substitute vegetable oil (usually olive, sometimes sesame or peanut). I still bake with butter, although sometimes I substitute olive or canola oil for half the butter called for in the recipe
- Chicken skin… this technique works best when you remove the skin before cooking and allow the marinade or sauce to infuse the meat itself. If you remove the skin after cooking, the meat often lacks flavor.
- Whole milk… we drink skim in everything except coffee. (I can’t give up cream in my coffee.)
Things I’ve added or increased:
- I eat lots and lots of fish, including all varieties of shellfish. I try to cook wild salmon at least once a week, because I’ve read that it is especially beneficial.
- Whole grains… I’m not a complete purist about it, but I try to look for 100% whole wheat breads and whole wheat pasta. I also eat a lot of that steel-cut oatmeal. It’s not only healthier, but it also tastes 50 times better than regular oatmeal.
- I’ve increased my vegetable portions and tried to eat a wider variety of leafy greens and veggies of all kinds. When I eat out, I try to only eat vegetarian, which forces me to eat a lot of vegetables and soy.
Other stuff:
- I still eat whole eggs about 3 times a week, either boiled or fried in olive oil
- I still eat small portions of cheese as a snack at least 3 times a week
- I have not lost any weight on this diet, but even with a BMI of 29 (yes, I know it should be lower), I’ve managed to lower my cholesterol almost 30% which is significant, I think.
Obviously dietary changes won’t work for everyone, and everyone has a different body chemistry, but for me they worked. I hope this info is helpful to anyone interested in trying it out.
— a BrooklyniteMy boyfriend had high cholesterol, high blood pressure and we thought he’d have to take medication. Instead, we both went vegan and exercised more. He went from 252-in the 140’s. I didn’t have high cholesterol. Now he has perfect, normal blood pressure and is all around healthier.
I think you can be healthy even if you eat meat and cheese (but I would never ever go back) as long as you limit your intake of processed foods and white flours and refined sugars. Those foods have little place in anyone’s diet, low cholesterol or high.
— Mv