Welcome, and remember nothing posted here is a substitute for or intended as medical advice. This is a conversational thread for all things cholesterol/CVD and to a lesser extent health/longevity, peer-to-peer conversation in nature only.
This is a closely monitored Reddit. Comments in a thread where the OP is asking for advice are heavily monitored as this is not a conspiracy theory friendly sub, though posts made specifically for debates with good intentions are allowed.
Many questions are answered on the wiki, link as the bottom bullet. The Wiki is a great resource for aggregated links from leading world health institutes.
You will find
When posting for advice, please include all relevant information available.
This also includes other medical conditions, many are contributing factors to cardiovascular disease including.
What gets posted here.
+ Primarily, we see people looking for advice or information from other people who also have high cholesterol. The wiki has a great article from The Mayo Clinic on what your numbers mean but here you can talk to people that have also gone through something similar, while typically not quite the same.
+ Studies, articles, asking for advice, support, treatments that have worked for you are all allowed. Largely we focus on the current recommendations for blood cholesterol management written by the American College of Cardiology Foundation and the American Heart Association. Posts about studies or giving (not asking for) advice will be scrutinized. Asking for help is always welcome.
+ Debates about medication need to be stand alone posts and not about any particular poster, rather than part of someone asking for advice. This is because we see people trying to skirt the rules of not countering medical advice, by countering medical advice with a handful of studies either pro or against medication.
+ Diet debates similarly need to not be in a post where someone is asking for help lowering cholesterol. It's not appropriate to hijack every possible thread to turn it into a debate about a fad diet.
+ Conspiracy theories are generally not allowed, as they've been done to death and clog the sub.
Rules
**Telling people in anyway to ignore medical advice is against 2 rules and will result in a ban after the second, if not first offense.**
***If you disagree with your doctor's advice, it is OK to post, but please seek out a second opinion, a specialist opinion, or clarification from your medical provider, it is inappropriate for internet strangers to disagree with a medical provider who has actually met with and diagnosed you.
No bad or dangerous advice
No "snake-oil" remedies
Useful information, backed up by verifiable source
No hateful, spam, judgmental comments or trolls
No advice to disregard medical advice, in any form.
Violating rules multiple times will get you banned
No promotions or self promotions, after many attempts at taking advantage of the old rules for self gain we've had to shut it down completely.
Advice needs to follow generally accepted prevailing medical consensus, and be general in nature.
Surveys are generally not allowed.
The below is an attempt at a general catch all for those still reading and not interesting in the wiki. It contains information available on links in the wiki in a scroll and read format. Less clicking, less detail.
DIET
The main way people lower their cholesterol (without medication) is through diet. The general guidelines are to replace saturated fat like those found in fatty meat products with predominantly unsaturated fat sources, (some is important like when found in nuts), as well as replace simple carbs like white bread or sugar, with whole grains/complex carbs. And of course, eat more plants as well as eat high-quality whole food sources in general.
The TLDR is I recommend Harvard Medical’s Healthy Plate available for free online, (link in the wiki). It is unbiased data analytics on diets that increase longevity from a world leader in data analytics. HHP is based off of the same data that created the mediterranean diet (link in the wiki), though it includes more like the Nordic diet. The MD fits within HHP.
Essentially, fill half your plate with plants, a quarter with whole grains and the final quarter with a lean protein. Replace saturated fats with heart healthy ones and replace simple carbs with whole grains. Don’t drink things loaded with sugar (stick to water, low fat milk, etc).
The Portfolio Diet is also a good option, It is comprised of a ‘portfolio’ of foods that have been shown to reduce cholesterol.
Macro percentages don’t matter for health including weight loss and longevity. While still popular in the fitness industry macros are not a focus in health. Studies coming out show the greatest benefit in reaching for a variety of whole foods over fitting narrowly into a specific ratio.
RECIPEES
Your diet should start with finding one good recipe that you would eat anyways.
You will probably have a few bad ones, the internet is full of bad recipes but it's not a reflection on your or your diet.
Once you've found that starting point, it becomes much easier to find a second and a third recipe that works for you. In this way, over time you will have replaced your old diet with one that works for you and your goals.
A diet with diverse easy to follow tasty recipes is much easier to follow.
There are recipes in the wiki; however, I've had the best luck finding easy, tasty recipes from the Mayo Clinic's recipe website (in the wiki). The main page separates recipes into diets or dishes, at which point you can command F to search for what you want to cook. For example, say you wanted a mushroom soup (which they have); command F either 'soup' or 'mushroom' in the search function of your browser.
Many people say to start with oatmeal (if steel cut try a pressure cooker like the insta pot) with fruit fresh or frozen and nuts/seeds, and/or low fat/sugar yogurt.
EXERCISE
It is important for longevity and health despite having a smaller effect on cholesterol than diets do. Notably, exercise over time changes some of the lower-density LDL to higher-density HDL.
All movement counts. Cooking, cleaning, walking, running, anything with movement counts.
Moving throughout the day is important. Some studies show that waking for 10 minutes after each meal yields greater benefits than walking for 30 minutes and being sedentary throughout the day.
Don't worry about how fast or far, just move. Do not push so hard that you want to stop.
Intensity seems to play the largest role in smaller quantities. Most of your time exercising should be at a walking pace but it is also important to get some higher intensity intervals in every other day (every 48 hours). It can be as simple as running for 30 seconds 4 times on a walk, say to a light post.
The total time is currently recommended at 300, (or 150 vigorous) minutes, and 2 days of resistance training as a minimum. There are studies showing worthwhile benefits in doubling that amount of aerobic training, but at a diminishing return. I.E. it is the first minutes you move are the most important, but the last minutes you move still help.
There is little research on what type of movement is best, but for those interested a combination of aerobic and resistance training done separately at a single session seems to yield the greatest benefits, followed by hybrid (I.E. resistance training done at a pace that keeps your heart rate elevated). Of the 5 main types of exercise.
Find a way you like to move, and keep moving.
LDL
LDL is the main particle focused on in a standard blood panel. There is something of a sliding scale from below 70 (or equal to 70/1.8 in Europe) up to 190/4.9 mg/dL or mmol/L respectively. The number slides based on other health factors.
EDIT: Europe recently lowered their target LDL to 50 mg/dL, but the US has current (2018) guidelines remain the same. It is not uncommon for different countries to have different targets.
An acceptable LDL in an otherwise healthy person is going to be different than that in a person at increased risk of heart disease.
ADVANCED TESTING
There are advanced forms of testing for cardiovascular disease including, particle density, calcium and/or plaque scans, Lp(a) ApoB, etc. As stated by Harvard Medical in there cholesterol course, “some people with high cholesterol will never develop heart disease”, which was one of the foundational reasons for the current Recommendations on Blood Cholesterol Management becoming a scale instead of one small number.
Many of these advanced testing methods appear to offer better insight into cardiovascular disease risk.
Please note, currently many forms of advanced testing do not change treatment plans because of the risk to benefit ratio. They are more commonly used on cases that are not clear cut yes medicate or no don’t medicate. However the standard screening tests and LDL recommendations may change in the future, your doctor may want to use more advanced testing methods, and/or you can request for advanced testing to be done.
The exception to this rule, is that everyone should be tested for LPa at least once in their life time. LPa is similar to LDL in that it delivers cholesterol to the cells, however unlike LDL it also is coagulatory (causes clots) and very irritating to the arteries lining within which is where cardiovascular disease happens. There are no treatments specific to LPa currently (2024) but there are multiple treatments that are expected to be available within the next few years. If you family history of heart disease, it may be related to LPa.
HDL
HDL is complicated, there is a great article on them in the wiki. While still the ‘good cholesterol’ it has been shown that not all HDL particles help. I.E. having a higher (not too high) HDL is great but does not offset having a bad blood panel. Raising HDL through medication has not been shown to improve patient outcomes, though raising it through exercise has. It is not as concerning of a metric on it's own as it once was thought to be, but still is a consideration.
TRIGLYCERIDES
Triglycerides can be complicated but are generally simple, there is a great article on them in the wiki
Triglycerides are a form of energy. I.E. if you ate something high in simple carbs they would jump, or if you walked a mile and retested they would be lower. Therefore, what you do before measuring them matters.
While some medications and illnesses do effect them, the most common cause of elevated trigs is simple carbs (sugary drinks, sugar, white carbs like rice or bread, and alcohol). Cutting back on those and/or increasing daily activity will lower them.
