In the years following World War II, physicians in the U.S. and Europe noticed a surprising phenomenon: rates of heart attack and stroke fell dramatically in many places. Autopsies from this period also revealed reduced rates of atherosclerosis, which is a buildup of fatty arterial plaques that causes cardiovascular disease.
At first, experts were perplexed. But as time passed, many concluded that wartime food deprivations and the forced shifts in people’s diets—namely, big reductions in the consumption of red meat and other animal products—contributed to the heart-health improvements. Later work, particularly the famous Framingham Heart Study, helped establish that blood cholesterol levels, driven in large part by a person’s diet, tended to overlap closely with cardiovascular disease.
The idea that the foods a person eats could raise or lower their risks for unhealthy cholesterol levels and disease was, at first, a radical and controversial one. While there’s ongoing debate about the relationship between red meat and poor health, the links connecting diet, cholesterol, and cardiovascular disease are beyond doubt.
Cholesterol is a waxy compound that your body uses primarily to make hormones and to firm up the walls of cells. “Our body needs some cholesterol for day-to-day functioning, but the amount our body needs is relatively small,” says Dr. Laurence Sperling, the founder and director of the Heart Disease Prevention Center at Emory University in Atlanta.
Different parts of the body, including the brain and the blood, contain cholesterol. It’s the oversupply of cholesterol in the blood, specifically, that causes problems—specifically low-density lipoprotein (LDL), which is also known as “bad cholesterol. Too much LDL in the arteries can “form a fatty streak, which is the precursor of atherosclerotic plaque,” explains Dr. Francine Welty, a cardiologist at Beth Israel Deaconess Medical Center in Boston and former chair of the American Heart Association’s lipid committee. LDL, therefore, is the primary building block of arterial plaque.
The two main diseases associated with clogged arteries—coronary artery disease and cerebrovascular disease—are both among the top three causes of death worldwide. More than 1 in 4 deaths are caused by one of these two conditions, and managing or lowering your blood cholesterol levels is a proven way to prevent these diseases. Sperling says ideal or “target” cholesterol levels vary depending on a person’s age, sex, and health status. But, optimally, you want to keep your LDL cholesterol below 70 mg/dL. While drugs can help people get there—and in some cases may be necessary—he says that non-pharmacological approaches are just as important. “Lifestyle and behavioral approaches are the foundation of cardiovascular prevention for all,” he says.
Here, experts detail the most impactful lifestyle changes to make to lower your cholesterol. A proper diet, they all agree, tops the list.
How to eat to lower your cholesterol
One of the biggest trends in diet and nutrition advice is a movement away from talking about specific micronutrients and optimal daily servings of this or that food group. Instead, nutrition experts now talk a lot more about broad patterns of healthy eating. This means limiting certain foods while prioritizing others, rather than trying to hit narrow targets.
“Something I tell a lot of my patients is that the Greek derivation of diet is diaeta, which means a way of life,” Sperling says. “Dieting shouldn’t be torture, or something you maintain for a month. It should be a meaningful and purposeful change you can extend throughout your life.”
In this spirit, he says one of the most important changes you can make is to pack your meals with lots of fresh fruits, vegetables, nuts, and whole grains. Many of the most effective and evidence-backed cholesterol-lowering eating plans—like the Mediterranean diet—prioritize these foods, he says.
Meanwhile, reducing your intake of animal products—especially red meat and processed dairy foods—is a move that research has repeatedly tied to cholesterol improvements. “I’ve run the lipid prevention clinic at my hospital for 31 years, and the first thing we tell people is to lower their intake of saturated fats,” Welty says. She mentions red meat, butter, and dairy as foods people should aim to cut down on—not eliminate necessarily, but reduce—if they want to improve their cholesterol. Many Americans consume saturated fats, from eggs and dairy products to red meat, with almost every meal. This sort of immoderation is a problem. “The Japanese have some of the lowest rates of cardiovascular disease in the world, and that may be because they eat much less red meat and saturated fat than we do in America,” Welty says.
It’s worth noting that saturated fat is a controversial topic in nutrition research. Some experts have argued that saturated fats get blamed for health problems that are likely caused by processed meats, refined carbohydrates (like those found in sugary or packaged foods), and the trans fats in fast foods and some packaged snacks. Others have argued that if people avoid meat and dairy but end up eating more processed or refined carbs, that’s an unhealthy trade. On the other hand, experts generally agree that trading saturated fats for some of the healthy foods mentioned above—such as fruits, vegetables, and nuts—is a highly effective way to improve your cholesterol scores and heart health. “If you decrease the saturated fat in your diet, that’s one of the best ways to lower LDL,” Welty says.
She adds that protein-rich soy-based products—from tofu to soy milks and yogurts—may also be good substitutes for meat, butter, milk, and other conventional saturated fat sources. “People in America are fixated on protein, but Americans don’t really like to eat soy products,” she says. This is unfortunate because research stretching back several decades has linked soy to improved heart health and lower blood cholesterol levels. “If you need to replace saturated fats with other proteins, soy would be a good option,” she says.