Statins are a common, safe, and effective way to lower “bad” low-density lipoprotein (LDL) cholesterol, which can build up in artery walls and increase the risk of heart attack and stroke. But some people want to see how much progress they can make with lifestyle changes before starting medication. While diet and exercise won’t replace statins for everyone, doctors say certain habits can meaningfully lower cholesterol and improve overall cardiovascular health.
One of the most powerful ways to improve cholesterol is to eat more minimally processed plant foods, including fruits, vegetables, legumes, nuts, seeds, and whole grains.
These foods contain plant sterols—natural compounds that resemble cholesterol and help block its absorption in the digestive tract. Sterols are found in vegetable oils, nuts, seeds, whole grains, vegetables, and some fortified products. Getting about 2 grams (2,000 milligrams) of plant sterols per day can lower LDL cholesterol by 8% to 12%.
Whole plant foods are also rich in antioxidants, which may help reduce oxidative stress. “For LDL to be incorporated into plaque, it has to be oxidized,” Elizabeth Klodas, MD, FACC, a preventive cardiologist and founder of Step One Foods, told Health. “Antioxidants help reduce the impact of even elevated LDL on our vasculature.”
Fiber is often overlooked, but it plays a central role in cholesterol control. More than 90% of women and 97% of men don’t get enough fiber, according to federal dietary guidelines.
Not all fiber works the same way. Soluble fiber—found in oats, barley, beans, lentils, chia seeds, flaxseed, apples, and psyllium—has the strongest LDL-lowering effect. It forms a gel-like substance in the gut that “binds cholesterol in the intestinal tract and escorts it out” to prevent reabsorption, said Klodas.
Research shows that consuming 5 to 10 grams of soluble fiber per day can reduce LDL cholesterol by about 5%. A bowl of oatmeal, a half-cup of beans, and a tablespoon of ground flaxseed can easily put you in that range.
Saturated fat can raise LDL cholesterol and is found in red meat, butter, cheese, coconut oil, palm oil, and many processed foods. (Tip: saturated fats can be easily identified because they stay solid at room temperature.)
Replacing saturated fats with unsaturated fats—such as olive oil, nuts, seeds, and fatty fish—can improve cholesterol levels. Omega-3 fatty acids, found in salmon, sardines, trout, flaxseed, and walnuts, don’t directly lower LDL, but they reduce triglycerides and support heart health overall.
“Replacing saturated fats with unsaturated fats further improves cholesterol levels,” Elisabeth Plotner, MD, DABFM, DipABLM, a board-certified family and lifestyle medicine physician, told Health.
Some eating patterns are specifically designed to lower cholesterol. One option is the Portfolio Diet, which combines four proven LDL-lowering components: plant sterols, soluble fiber, soy protein, and nuts.
When followed consistently, research suggests this approach can reduce LDL cholesterol by up to 30%—an effect comparable to a starting dose of a first-generation statin drug for some individuals. Meals might include oatmeal topped with almonds, lentil soup, and tofu stir-fries.
Other heart-healthy patterns like the Mediterranean and DASH diets also incorporate many of these principles.
While saturated fat often gets the spotlight, refined carbohydrates and added sugars can raise triglycerides and worsen overall cardiovascular risk. Sugary drinks, white bread, pastries, and ultra-processed snacks can contribute to insulin resistance, which negatively affects cholesterol levels.
Swapping refined grains for whole grains and limiting added sugar can improve triglycerides and HDL (“good”) cholesterol and support overall metabolic health.
Exercise is another powerful tool for improving cholesterol. The American Heart Association recommends at least 150 minutes of moderate-intensity aerobic exercise per week (or 75 minutes of vigorous exercise), plus two days of strength training.
Physical activity can raise HDL cholesterol, lower triglycerides, and reduce visceral fat—the metabolically active fat stored around internal organs that contributes to cardiovascular risk. Additionally, for people carrying excess weight, losing just 5% to 10% of body weight can significantly improve cholesterol levels and triglycerides.
If you’re currently sedentary, even small increases in daily movement can make a difference
Chronic stress and poor sleep can negatively affect metabolic health. Elevated stress hormones such as cortisol may worsen cholesterol patterns over time, and inadequate sleep is linked to insulin resistance.
Limiting alcohol is also important. While moderate drinking was once thought to benefit heart health, alcohol can raise triglycerides—even in modest amounts.
Avoiding tobacco and minimizing ultra-processed foods further support heart health.
Certain supplements have some evidence behind them. Psyllium supplements can lower LDL cholesterol by about 7%. Plant sterol supplements may also help if dietary intake is insufficient. Omega-3 supplements can reduce triglycerides, though they don’t significantly lower LDL.
You should always speak with a healthcare professional before starting supplements. Some products may carry side effects or interact with other medications or supplements.
Sometimes lifestyle changes alone might not be enough, and a combination of healthy habits plus medication is needed to bring cholesterol levels down.
For some people, high cholesterol is genetic. Individuals with LDL levels of 190 mg/dL or higher may have familial hypercholesterolemia, a condition that often requires medication regardless of lifestyle.
Doctors also look at overall cardiovascular risk—including family history, blood pressure, diabetes, and other factors—when deciding whether medication is necessary. In general, individuals with a calculated 10-year risk of heart attack or stroke of 7.5% or higher may need medication if lifestyle changes alone aren’t enough, said Plotner.
Lifestyle changes don’t work overnight. Most cholesterol improvements appear within four to twelve weeks. That’s why clinicians typically recommend repeating blood work after about three months of consistent changes.
Sometimes lifestyle adjustments are sufficient. Other times, medication plus healthy habits offers the greatest protection.
You don’t have to overhaul everything at once. “Even tiny changes add up,” said Klodas. “We eat an apple for one day, it won’t do much. But eating an apple every day for a year adds up to a lot of fiber, micronutrients, and antioxidants.”
