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Controlling Cholesterol The Natural Way

Heart shaped platter of fruits, vegetables and grains on a wooden surface representing Healthy foods and supplements for controlling cholesterol the natural way

Kenneth H. Cooper, MD, MPH, Founder and Chairman of Cooper Aerobics, knows a thing or two about heart health and the conditions that impact it, including the importance of maintaining healthy cholesterol levels. The internationally recognized “father of aerobics” first published Controlling Cholesterol the Natural Way in 1999, which features a step-by-step plan for lowering cholesterol without the use of prescription drugs. In this article, we will examine how well those recommendations have stood the test of time.

Over the last 25 years, robust clinical data have demonstrated the benefits of a number of classes of cholesterol-lowering prescription medications (moderate and high-intensity statins as well as non-statin medications such as PCSK-9 inhibitors) in reducing the risk of fatal and non-fatal heart attack and stroke in moderate and high-risk patients. However, improving health habits is still an important recommendation for patients with high cholesterol at any risk level, particularly lower-risk patients who don’t need to take prescription medication.

Summary: Controlling cholesterol the natural way is possible through a combination of diet, exercise, functional foods, and targeted supplements†. While prescription medications are often necessary for higher-risk patients, lifestyle changes remain the foundation for supporting healthy cholesterol levels at any age†. This article reviews the key components of cholesterol, Dr. Kenneth H. Cooper’s step-by-step recommendations, and how current research supports natural strategies for long-term heart health†.

Table of Contents

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Understanding a Lipid Panel for Cholesterol Control

In order to understand how to improve your cholesterol profile, it’s helpful to review the  different components measured in a lipid panel:

  • Total Cholesterol (the sum of LDL, HDL, plus VLDL)
  • LDL (low-density lipoprotein) cholesterol
  • HDL (high-density lipoprotein) cholesterol
  • VLDL (very-low-density lipoprotein)
  • Triglyceride level

Depending on how the lipid profile is ordered by your health care provider, the middle three components (LDL, HDL, and VLDL) may be measured individually and summed to determine the total cholesterol level.  Alternatively, the HDL and triglyceride levels may be directly measured, and then the LDL and VLDL levels are calculated using a validated formula.  Thus, you may see the LDL value on a lab result described as “calculated” or “direct.”  Typically, it is less time-consuming and less expensive to directly measure only two components and calculate the others.

What is LDL Cholesterol?

LDL, referred to as “bad cholesterol,” can enter the inner lining of artery walls and trigger an inflammatory response that leads to the buildup of plaque, also known as atherosclerosis. High levels of LDL increase the risk of atherosclerotic cardiovascular disease (ASCVD), which includes heart attack, stroke, aortic aneurysm and peripheral arterial disease (atherosclerosis in the arteries in the lower extremities).  Furthermore, numerous clinical trials using different medications have demonstrated a reduction in ASCVD risk, which increases with greater LDL reduction. Thus, high LDL is a common target for cardiovascular risk reduction recommendations.

An optimal LDL level for an individual patient depends on their cardiovascular risk profile. For example, a patient with a history of coronary bypass surgery and diabetes has an LDL treatment goal of < 55 mg/dL.  A patient with multiple cardiovascular risk factors but no history of clinical cardiovascular events has an LDL treatment goal of <70 mg/dL.  For a younger patient with no risk factors for heart disease and no evidence of calcified plaque in their arteries, an LDL level of 100-130 may be acceptable.

What is HDL Cholesterol?

HDL is commonly referred to as “good cholesterol.”  This is because epidemiological studies, such as the Framingham Heart Study, have shown an inverse relationship between HDL and the risk of atherosclerotic cardiovascular disease.  HDL has been shown to have cardioprotective functions, including preventing inflammation and oxidative stress in arterial walls, as well as promoting cholesterol removal from the arterial wall to reduce atherosclerotic plaque formation. However, the cardioprotective role of a high HDL level has been called into question by more recent studies that have shown (1) people who are born with genetically driven high levels of HDL do not have a lower risk of developing atherosclerotic cardiovascular disease, and (2) clinical trials of medications used to increase HDL have not been shown to reduce cardiovascular risk. Ongoing studies now suggest that absolute HDL levels do not necessarily reflect the cardioprotective function of HDL.

How Lifestyle Affects HDL Cholesterol

Genetics appears to play the most significant role in determining HDL levels, but lifestyle choices can also affect HDL. Reductions in HDL are also associated with smoking, being overweight, being sedentary, insulin resistance, high triglyceride levels, having a diet high in refined carbohydrates (added sugars) and trans fats.  At this point, improving unhealthy lifestyle habits is the best way to increase HDL.  There is no optimal level or target for HDL, given the complex relationship between HDL levels and function.  The general approach is “the higher, the better” because higher values imply achievement of optimal cardiovascular health habits.

Triglycerides and Cholesterol: What You Should Know

Triglycerides are the most common type of fat in the blood and serve as the body’s primary source of energy. Triglycerides are found in higher-fat foods such as butter, oils, eggs, cheese, red meat, fried foods and creamy sauces and dressings—foods that deliver calories the body may not need right away.  Individuals with elevated triglyceride levels are at increased risk for cardiovascular complications, particularly atherosclerosis; the mechanism of this increased risk is a topic of active research.

A healthy level of triglyceride is < 150 mg/dL. Prescription drug treatment is often not recommended unless the triglyceride level is >500 mg/dL due to an increased risk of pancreatitis. Older trials of drug therapy aimed at reducing cardiovascular risk by lowering triglyceride levels have not demonstrated a benefit. The impact of triglyceride reduction on cardiovascular risk using commercial omega-3 fatty acids is a topic of considerable debate.

Finally, because total cholesterol is comprised of multiple components with varying levels of cardiovascular risk associated with them (high LDL carries a high risk and high HDL a low risk), it is challenging to define ideal total cholesterol values.  For example, a patient with a low LDL and high HDL may have the same total cholesterol value as a patient with a high LDL and low HDL level, but these patients would have different cardiovascular risks.

Cholesterol
Type Optimal Levels
LDL (bad) Cholesterol No heart disease risk factors: 100-130 mg/dL

Multiple cardiovascular risk factors/no history of events: < 70 mg/dL

Coronary bypass history and diabetes: <55 mg/dL
Triglycerides < 150 mg/dL

In summary, while drug treatment for LDL reduction may be strongly recommended for patients at higher risk, improving cardiovascular health habits is recommended for all patients, regardless of their risk level.

In his book, Dr. Cooper spelled out five steps for Controlling Cholesterol the Natural Way:

Dr. Cooper’s 5 Steps for Controlling Cholesterol the Natural Way

  1. Low-Fat, Low-Cholesterol Diet. Reduce total cholesterol by 15 percent or more with a low-fat, low-cholesterol diet. (Specific guidelines are featured below.)
  2. Regular Exercise. Raise “good” HDL cholesterol by 10 percent or more through regular endurance exercise.
  3. Lose Body Weight. Every 5 to 10 pounds of excess body weight lost lowers total cholesterol by 5 percent.
  4. Designed Functional Foods. Reduce total cholesterol by 10 percent or more and “bad” LDL cholesterol by 14 percent or more by eating the daily recommended servings of a designed functional food, such as Benecol or Take Control.
  5. Traditional Functional Foods. Reduce total cholesterol by 5 percent by incorporating a conventional functional food into your diet, such as cereals rich in psyllium (including Kellogg’s® All-Bran Buds).

Diet for Controlling Cholesterol the Natural Way

The concept of dietary fat has undergone considerable evolution over the last two decades. There is little robust evidence to suggest that a high intake of total fat is harmful in terms of heart disease. Instead, dietary intake recommendations are divided into good fats, bad fats and neutral fats.

Trans unsaturated fatty acids (trans fats) are an example of bad fat. Trans fats are found in industrially produced hydrogenated oils; trans fats increase LDL and triglyceride levels and decrease HDL levels. Trans fat intake has also been shown to increase the risk of ASCVD. Furthermore, eliminating trans fats in commercially made food products has resulted in a decrease in cardiovascular disease events like stroke and heart attack.

Although many expert groups have advocated for reduced intake of saturated fats to reduce the risk of heart disease, this simply has not been supported by a robust evidence base. This may be in part due to patients’ tendency to replace saturated fat calories with refined or processed carbohydrates, which decreases HDL, increases triglycerides, and increases cardiovascular risk. In contrast, several observational studies have shown that a higher intake of polyunsaturated fats, in place of saturated fats, is associated with a reduced cardiovascular risk. Polyunsaturated fats will reduce LDL and may have anti-inflammatory properties as well.

Exercise for Natural Cholesterol Management

One of Dr. Cooper’s 8 Steps to Get Cooperized™—“Exercise most days of the week”—is also an effective way to help lower cholesterol. According to the American Heart Association, lack of exercise and unhealthy body weight work hand-in-hand to allow high cholesterol to go unchecked. Aerobic endurance exercise helps eliminate LDL (bad) cholesterol from the bloodstream while increasing HDL (good) cholesterol, and aids in reducing body weight.

One hundred fifty minutes of moderate-intensity aerobic exercise—or 75 minutes of vigorous exercise—each week, along with strength training twice a week, can be an effective way to reduce body weight and total cholesterol. Brisk walks, jogging, cycling, swimming and dancing are good examples of effective aerobic exercise. If you’re not already on an exercise regimen, start slow and stick with it. The more you do it, the easier it gets and the greater positive effects it will have on your heart health.

Supplements That Support Healthy Cholesterol†

For patients who do not require or do not wish to take prescription medication to lower their cholesterol, nutritional supplements may be used to help improve cholesterol levels†. These supplements include:

  • Omega-3 fatty acids, high in EPA (Eicosapentaenoic acid) and DHA (Docosahexaenoic acid), can reduce triglyceride levels and may reduce cardiovascular risk in those patients who do not include fatty fish in their diet at least twice a week†. (For more information, read “What a Cardiologist Wants You to Know About Omega-3 for Heart Health.”)
  • Berberine supplements reduce cholesterol through several mechanisms†. In a meta-analysis of six clinical studies, the addition of berberine reduced total cholesterol, LDL cholesterol and triglycerides†. Cooper Complete Berberine Complex is typically taken three times daily. (See more in-depth information in “Can Berberine Help Lower LDL Cholesterol?“)
  • Soluble Fiber, found in psyllium, pectin, wheat dextrin, some beans, lentils, nuts, and oat products, can reduce total and LDL cholesterol through several mechanisms†. Eating 5 to 10 grams of soluble fiber a day can help lower total and LDL cholesterol by 5-11 points†. Cooper Complete Microbiome Fiber is a tasteless and gritless daily prebiotic soluble fiber supplement that also supports gastrointestinal health and regularity and contains 6 grams of soluble fiber per scoop†. (See “Health Benefits of Fiber Supplements” for more information.)
  • Plant stanol/sterols (phytosterols) are natural plant compounds that may block the absorption of dietary cholesterol†. Clinical studies suggest that 1-3 grams of daily intake, taken with meals, can be effective. Consume 1 gram with the two largest meals each day to help lower cholesterol as much as 7-15 percent†. Cooper Complete Plant Sterols contains 1.3 grams of plant sterols per serving, which is equivalent to two capsules†. (For more information, see “The Health Benefits of Plant Sterols.”)

Frequently Asked Questions About Controlling Cholesterol the Natural Way

Can you lower cholesterol naturally without medication?

For many individuals with mild to moderate cholesterol concerns, lifestyle modifications can play a crucial role in maintaining healthy cholesterol levels†. Eating a diet rich in whole foods, exercising regularly, maintaining a healthy weight, and considering certain functional foods or supplements are common strategies. Always consult your physician before making changes to your health plan.

What foods help support healthy cholesterol levels?

Foods high in soluble fiber, such as oats, beans, lentils, apples, and psyllium husk, may help support healthy LDL cholesterol†. Nuts, seeds, and fatty fish rich in omega-3 fatty acids are also good additions to a heart-conscious diet.

How much exercise helps cholesterol?

Guidelines recommend 150 minutes of moderate-intensity aerobic exercise per week, or 75 minutes of vigorous exercise, along with two sessions of strength training. Regular activity supports a healthy weight and may help balance HDL and LDL cholesterol†.

Do supplements really help with cholesterol?

Some supplements, such as omega-3 fatty acids, plant sterols, soluble fiber, and berberine, have been studied for their potential to support healthy cholesterol levels†. They are not a replacement for prescription medications when those are needed, but they may complement lifestyle changes for individuals seeking natural support†.

Final Thoughts on Controlling Cholesterol the Natural Way

While prescription medications remain an important option for many patients, lifestyle strategies are the foundation of heart health. Eating a balanced diet, exercising regularly, maintaining a healthy weight, and incorporating functional foods or supplements can all help support healthy cholesterol levels†. By following Dr. Kenneth H. Cooper’s time-tested approach, you can take proactive steps toward naturally controlling cholesterol and promoting long-term cardiovascular health†.

It is always important to consult your physician or health care provider before adding a new supplement to your regimen. They understand your health profile best, so it’s important to talk to them about which supplements are best for you.

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Medically Reviewed By: Nina B. Radford, MD, FACC, Cooper Clinic Cardiologist and Director of Clinical Research.

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