How to Control High Cholesterol, According to Patients – TIME

There are a variety of factors that influence cardiovascular risk—but cholesterol is one of the first things that doctors pay attention to.

Having high levels of low-density lipoprotein (LDL) cholesterol is “definitely a variable we try to manage, because it’s been shown to be problematic for heart health,” says Dr. Adriana Quinones-Camacho, a cardiologist at NYU Langone Health.

Though it’s often called the “bad” kind of cholesterol, LDL cholesterol makes up most of your body’s cholesterol stores. That means it’s not a villain on its own, but when levels start creeping up, excess LDL can contribute to plaque formation in your arteries. Known as atherosclerosis, this condition increases the risk of heart attack and stroke. The U.S. Centers for Disease Control and Prevention notes that about 93 million American adults have high cholesterol, which represents about 36% of the U.S. adult population.

High cholesterol is sometimes treated with medications like statins, depending on factors such as age and family history, but lifestyle changes tend to be the first treatment, Quinones-Camacho says. That’s especially true if someone is younger than 45 and has fewer risk factors overall.

Taking steps to keep cholesterol in check is crucial not just for heart function, but for overall health. Here, six people who have been diagnosed with high cholesterol share the strategies that help them manage it most effectively.

Choose your fats wisely

Likely due to genetic factors, Brian Jones, 32, who lives in Edmonton, Canada, has always had high cholesterol, and he finds that watching his fat intake helps keep his numbers controlled.

That doesn’t mean cutting out all types of fat, however—research indicates that this macronutrient plays a role in regulating appetite, helping you feel full, absorbing certain types of vitamins, and storing energy in the body. But the type of fat you choose matters.

“Consuming a lot of foods high in saturated and trans fats may make you more likely to develop high cholesterol, so I eat less of those,” Jones says. That includes fried foods and fatty meats, for example. Instead, he focuses on foods with omega-3 fatty acids, like walnuts, salmon, flaxseeds, and mackerel. When he cooks, he opts to use olive oil or avocado oil.

The benefits of omega-3s on cardiovascular disease have been studied extensively, and research in the journal Nutrients finds that part of the effect comes from improving cholesterol numbers.

“Making choices like these is important,” Jones says. “These might seem minor, but they add up to healthier food decisions every day, and that’s huge for helping me manage my high cholesterol.”

Read More: What to Know About High Cholesterol in Kids

Focus on less sugar and more fiber

In addition to selecting healthy fats, emphasizing more fiber in your diet can be a boon if you have high cholesterol. That often means choosing more fruits, vegetables, and whole grains, which has been helpful for Mark Joseph, a 32-year-old Missouri resident. When he was first diagnosed with high cholesterol a few years ago, he knew it was time to shift his lifestyle, and that began with major changes in how he was eating.

Joseph cut way back on fried food, alcohol, and sugar, which have all been shown to affect heart health in negative ways. For example, research from Boston University found drinking just 12 ounces of a sugary beverage daily is linked to higher levels of LDL cholesterol. Another study, published in Progress in Cardiovascular Diseases, noted that consumption of added sugars like high fructose corn syrup increases the risk of high cholesterol and coronary heart disease.

Joseph now tracks his daily fiber intake, and concentrates on getting sufficient amounts from food sources, rather than supplements. In part, that’s because he’s discovered a breadth of delicious options: steel cut oats and fresh fruit for breakfast, steamed vegetables and a lean protein like chicken for lunch, and a side of whole grains like quinoa for dinner. The more healthy choices Joseph adds, the less he misses his old favorites. “Another benefit to eating more fiber is that it makes me feel full, so I don’t crave snacks as much,” he says. “That’s in addition to lowering my LDL cholesterol.”

One of the reasons fiber is so beneficial is that it reduces the absorption of cholesterol into your bloodstream. Just 5 to 10 grams a day—which isn’t much, considering one serving of oatmeal has 4 grams of fiber—can lead to significant improvements for those with high cholesterol.

If you’ve always had a sweet tooth, consider making fiber-rich fruits into a treat. That’s the tactic 52-year-old San Francisco resident Lucia Chang used to knock out her own dessert cravings. Specifically, she’s embraced eating all types of berries as well as bananas, and her total cholesterol levels have dropped by 17% over the past year, with no other changes to her diet.

“I’m thrilled by how easy this was and what a big difference such a small shift could make,” she says. “Now, a bowl of berries is a precious treat, and I don’t feel deprived.”

Make time to exercise

When 27-year-old Florida resident Jesse Feder was diagnosed with high cholesterol seven years ago, he wasn’t surprised since it runs in his family. But he didn’t anticipate how much working out consistently would help improve his numbers.

“I’d tried dietary changes like avoiding shrimp and eggs since they have high cholesterol, but that didn’t do anything,” he says. “In fact, when I ate them regularly, my numbers were exactly the same. What did help was exercising several times per week.”

Research backs up that result: A study in Sports Medicine found that any type of movement, including resistance training and aerobic exercise, can have a beneficial effect on cholesterol. The results were so significant that the researchers suggested clinicians encourage as much physical activity as possible for people with high cholesterol and other heart-health risks, such as high blood pressure.

For Feder, the effects of fitness weren’t just personal; they drove his choice of profession as well. Because he saw so many benefits when he began working out—including better mood, improved body composition, and consistent energy—he became a strength and conditioning coach. “Exercise has really helped me maintain a borderline high cholesterol level without needing to take medication,” he says.

Although he concentrates on structured exercise sessions several times per week, that doesn’t mean everyone needs to follow the same routine to see benefits. For example, Ava Collins, 25, who lives in Adelaide, Australia, started with just 10-minute bursts of activity as a way to manage high cholesterol. Sometimes that meant a walk after dinner; other times, spending time gardening. She gradually increased the intensity and duration of her movement and now logs about two to three hours of exercise per week.

One of the keys to fitness success, Collins says, is figuring out which workouts you most enjoy. “If you can find a workout buddy, that’s even better because it helps you stay on track, and you have a social component,” she adds. Collins has also enjoyed the stress-relief that’s associated with exercise, whether it’s gentle movement like yoga or a more vigorous dance workout.

“Stress can cause your cholesterol to skyrocket,” she says. For example, a study in the journal Medicine found that psychological stress increased risk of high cholesterol, but that physical activity could mitigate that risk.

Read More: How to Lower Your Cholesterol Naturally

Quit smoking

At just 28 years old, Texas-based Matt Kerr was shocked to find out he had high cholesterol and, even more alarmingly, an artery blockage. That’s when he learned that his daily smoking habit, started when he was a teenager, could be a contributing factor.

Kerr knew the addiction was bad for his lungs, but the degree of potential heart impacts was new to him, and he realized that if he didn’t ditch the cigarettes, his medications might not work as well as they should.

“I learned that smoking impairs your blood vessels, accelerates artery hardening, and significantly raises risk for heart disease,” he says. “Those effects don’t take decades to develop, either.”

Smoking makes LDL cholesterol stickier, so it’s more likely to cling to artery walls and cause problems. According to the American Heart Association, when smoking and high cholesterol are combined, your risk of heart attack is dramatically increased.

Research published in American Heart Journal found that even when participants gained weight from smoking cessation, their cholesterol numbers improved. Most notably, they had more HDL cholesterol—or high-density lipoprotein, the “good” kind—which helped their total cholesterol balance overall.

Take medication as directed

Although lifestyle changes like diet and exercise can be powerful, and in some cases delay the need for medication, that doesn’t mean cholesterol-lowering drugs should be avoided if they’re recommended by your health-care team. There’s an array of medication options now available, and having a conversation with your doctor can help you pinpoint which one might be a good fit, says Quinones-Camacho. “The good news about drugs like statins is that there are multiple choices, so if one isn’t working for you, there’s often another one that will work better,” she adds.

Sometimes, lifestyle changes can help someone lower the medication dose they need. For example, Joseph used to take a higher-dose statin, but since making significant dietary changes and adopting a consistent workout routine, he’s been able to switch to a low-dose statin. His doctor also prescribed niacin—a B vitamin that helps your body to turn food into energy—which his doctor prescribed as a way to raise HDL cholesterol.

While some supplements might be helpful for some people, it’s important to always talk to your doctor before trying them, especially if you’re on medication for your condition. Some supplements interfere with certain medications.

That’s a good approach in general, experts say: Checking in about appropriate exercise levels, dietary choices, weight gain or loss, and even the mental-health struggles that accompany managing a chronic condition should all be part of a conversation with your doctor.

“Although high cholesterol is seen as a risk overall, the fact is that every person is different, and how you approach your health will be unique,” says Quinones-Camacho. “Draw on your health-care team. You can find the support you need.”