In patients who have coronary artery disease, peripheral artery disease or carotid artery disease, there is no question about the benefit of cholesterol-lowering medications such as statins. However, for the rest of us who don’t have these diseases and don’t want to get them, how can we lower our cholesterol naturally?

There are several proven ways to lower cholesterol naturally.

“I frequently tell patients I treat that diet is key to help reduce cholesterol levels. A focus on a plant-based diet, reducing saturated fat and increasing fiber-containing foods like vegetables and whole grains has been shown to reduce cholesterol levels – with or without the use of statins,” says Dr. M. Wesley Milks, a cardiologist and associate program director of the cardiovascular disease fellowship at the Ohio State University Wexner Medical Center.

What Is Cholesterol?

Cholesterol is a waxy, fat-like substance found in the body and in many foods. You need some cholesterol for your cells to function normally and for your body to make hormones, vitamin D and even break down food during digestion.

But cholesterol can become problematic. Skewed levels of “good” cholesterol (high-density lipoprotein, or HDL) and “bad” cholesterol (low-density lipoprotein, or LDL), for instance, can threaten heart health. Too much bad cholesterol, coupled with high levels of a closely related blood fat known as triglycerides, can lead to hyperlipidemia, a condition characterized by high cholesterol.

“(Hyperlipidemia) can lead to the harmful buildup of atherosclerotic plaque – or fatty deposits – in your arteries, which may eventually cause heart attacks and strokes,” says Dr. Brian Lima, national physician director for cardiothoracic surgery, heart failure and transplant at HCA Healthcare in Dallas.

Causes of High Cholesterol

There are two primary reasons why your cholesterol might be high: lifestyle choices and genetics. Some people have a combination of both factors that lead to their high cholesterol levels.

For a long time, lifestyle choices, such as diet and exercise, shouldered much of the blame for high cholesterol. More recently, however, there’s been some controversy about how much diet and exercise can affect cholesterol levels. Rather, some people appear to have high levels because of their genetics rather than lifestyle factors.

“It’s true that for most people, dietary cholesterol intake per se, has a relatively small effect on cholesterol,” notes Dr. Deepak L. Bhatt, director of Mount Sinai Heart and the Dr. Valentin Fuster professor of cardiovascular medicine at the Icahn School of Medicine at Mount Sinai Health System in New York.

But that doesn’t mean you can eat whatever you want. Bottom line: If you have high cholesterol, you should be following a low-cholesterol diet. Reducing your consumption of saturated fat and sugar, for instance, can help bring your hyperlipidemia under control.

How to Lower Cholesterol Naturally

Using diet to help control hyperlipidemia “starts with paying attention to what you’re eating by reading food labels,” says Lima, who also serves as surgical director of heart transplantation and mechanical circulatory support with Medical City Healthcare. Be sure to check how much cholesterol is listed on the label and the amount of saturated and trans fats, which can be bad for heart health.

1. Replace unhealthy fats with healthy fats

Replace unhealthy fats – trans and saturated fats – with healthy fats, which are monounsaturated and polyunsaturated fats found mainly in plant foods like olive oil, nuts, seeds and avocados as well as fatty fish like salmon.

Trans fat should not be part of your diet. These kinds of fats lower good cholesterol (HDL) and raise your bad ones (LDL). Trans fats are often found in fast foods and convenience foods, such as cookies, crackers, vegetable shortening, fried foods, coffee creamer and other processed foods. Many food manufactures have already removed trans fats from their products, but be on the lookout for them. If the label contains the words “partially hydrogenated oil,” that’s a sign that the item contains trans fats.

In addition to avoiding trans fat, limit your saturated fat intake. Saturated fats are “the kind of fat that is usually solid at room temperature, such as fats in meat, butter, coconut oil, palm oil and full-fat dairy products, as well as a variety of packaged foods, snack foods and desserts,” explains Milks.

2. Increase your consumption of dietary fiber

Ideally, you should be getting 25 to 35 grams of fiber a day. Fiber binds to cholesterol and eliminates it from your body. You can increase your fiber by getting more whole grains, legumes (such as beans and lentils), vegetables and fruits.

There are two types of fiber: Soluble fibers are more beneficial for cholesterol, while insoluble fibers are better for your gut health. You should get good mix of both.

Some of the best cholesterol-lowering sources of fiber include beans, lentils, apples, blueberries, flax seeds and oatmeal. However, adding too much fiber too quickly can cause gastric distress (think: constipation or diarrhea). Increase your fiber intake slowly and drink plenty of water to help keep your gut happy.

3. Add flax to your diet

Flax is a soluble fiber: The benefit of flax has been known since Hippocrates’ time. It can lower triglyceride levels,. Flax also contains a plant omega-3 fatty acid called alpha-linolenic acid.

Flax is a good source of high-quality protein and potassium and contains lignans, which are phytoestrogen and antioxidants. Eat your flax – don’t take it in pill or oil form, since such versions lack fiber, lignans and protein. When you eat flaxseed, make sure you grind the seeds to get the most benefit. Also, put flax in the refrigerator as soon as you grind it. The whole flax can be stored at room temperature for one year, but once it’s grounded, it goes bad – so grind a little bit at a time. Aim for 2 to 3 tablespoons of ground flaxseed a day. Try putting it in your food, such as cereal, yogurt and salad.

4. Add plant sterols to your diet

“Cholesterol levels can drop further by incorporating supplements like plant sterols,” says Milks.

Plant sterols are naturally-occurring compounds that have a structure similar to that of cholesterol. Small amounts of these substances are found naturally in grains, fruits, vegetables, legumes, nuts and seeds. As they travel through the intestinal tract, they compete with artery-clogging LDL particles and prevent them from being absorbed into the bloodstream. Because of their cholesterol-lowering properties, sterols are now being added to a slew of products. Sterol-fortified options include margarine, orange juice, cereals, yogurt and granola bars. All are readily available at the grocery store.

5. Increase healthy proteins while reducing unhealthy ones

“For protein, non-fried fish is one of the highest quality sources you’ll find,” says Milks. “In particular, fish such as salmon and tuna have a special kind of unsaturated fat, called omega-3 polyunsaturated fatty acids, which which offer additional health benefits for lipids and metabolism. White fish is still a fine protein source, but you won’t get the added benefit of the omega-3 fatty acids. Plant-based options like tofu or vegan sausage can be great protein alternatives as well.”

The main distinction in choosing fish or plant-based proteins instead of other meats is the lack of saturated fat. The body turns that saturated fat into bad cholesterol. If you do eat meat, look for lean cuts and trim the fat before cooking. Opt for chicken or fish instead of red meat or pork. This helps reduce your saturated fat intake, Milks points out.

6. Cook with plant-based oils

Cooking with plant oil rather than butter also cuts out saturated fat, and some plant oils can also offer omega-3 acids. Olive oil is mostly monounsaturated fat, which is preferred over fats that are solid at room temperature like shortening. Better still, grapeseed, walnut and sunflower oil are excellent alternatives due to higher polyunsaturated fatty acid content, says Milks.

7. Get your heart pumping

Cardiovascular exercise can help keep your weight down and HDL levels up. Perform at least 20 to 30 minutes of moderate-intensity aerobic exercise daily. Examples include brisk walking or light jogging, swimming or cycling. On a scale of 1 to 10, you should feel like you’re working at about 4 to 6.

8. Quit smoking

Smoking can do a number on more than your lungs, actually reducing the body’s concentration of HDL cholesterol. Fortunately, it’s never too late to quit. If you smoke, you should quit as soon as possible. Try nicotine patches and gum to help tamp down cravings.

“Smoking can reduce your good cholesterol, or HDL, and is extremely detrimental to your heart health,” Lima says.

9. Go nuts

Eating a small serving of almonds (about eight kernels) daily is enough to raise HDL levels by as much as 16% after 12 weeks, according to research published in the Journal of Nutrition. Researchers believe the nutrients in almonds help limit the amount of LDL cholesterol that the body absorbs from foods while increasing the amount expelled by the body.

10. Moderate your alcohol

Higher alcohol consumption can drastically increase your risk of heart disease (not to mention other conditions). The National Institutes of Health recommends reducing alcohol intake or avoiding it altogether to help lower your blood lipid levels. If you do drink, keep yourself in check by limiting yourself to one drink per day if you’re female and two drinks per day if you’re male. One drink equals 12 ounces of regular beer, 5 ounces of wine or 1.5 ounces of distilled spirits.

11. Skip added sugars

Added sugars can boost your triglyceride levels quickly, so you may want to limit how much you consume, Milks says. Examples of sugar-heavy foods include:

12. Choose a plant-based diet

Animal products often contain cholesterol, so opt for plant-based foods to eliminate some of that dietary cholesterol. The data have been consistent for years, Bhatt says, that a plant-based, low-fat diet is good for heart health and can help you lower your cholesterol and triglyceride levels.

Meal Plan From a Cardiologist

Ideal menu to lower cholesterol

Milks offers his ideal menu for reducing cholesterol while still enjoying meals:

Breakfast
“My days typically begin with a high-protein yogurt with little sugar or saturated fat. I add a banana or citrus fruit, along with oatmeal or a whole-grain breakfast bar. On the weekends with my family, I’ll make egg-white omelets with fruit and a vegetarian sausage – a light and protein-packed breakfast.”

Lunch
“To me, lunch is the most controllable meal of the day. It’s often a choice of bringing food to work or stopping to get lunch while you’re out. I try to pack my lunch most days of the week.”

One of his favorite lunches is a citrus and greens salad with tuna or tofu crumbles on top and a black-bean soup or coleslaw (with vinaigrette rather than mayo) as a side. Other days, he’ll have a homemade lentil, tomato and portobello soup along with a sandwich of tuna and cucumber on whole-grain bread with a side of carrots or kimchi.

Snacks
“I like to have a little pick-me-up or something to munch on at work, but I want to avoid carbs and sweetened beverages,” says Milks.

He keeps nuts like almonds or pistachios at his desk and will sometimes add some dried fruit, though it’s important to watch out for sugar content. He drinks unsweetened tea or black coffee, and sometimes puts a slice of citrus in his water bottle.

Dinner
“For dinner, I try to keep my main course centered around fish or a plant-based protein source,” Milks explains.

An example would be a plate of salmon, roasted Brussels sprouts tossed in grapeseed oil, long-grain rice and a green salad. “Sometimes we’ll replace the salmon with a plant-based option or add non-starchy vegetables like broccoli or asparagus. Bulgur or quinoa are higher protein- and fiber-containing grain options compared to pasta or white rice.”

Healthy Foods to Lower Cholesterol

There’s a whole rainbow of delicious, healthy foods that can be part of your low-cholesterol diet. These include:

Working with a dietitian

No single diet is best for everyone, and what foods to eat for optimal health depend on whether you have certain health conditions, such as heart disease, diabetes or digestive problems, Milks says. Therefore, it’s best to ask your doctor or a registered dietitian about what diet is best for you.