Can Your Diet Lower Your Cholesterol?
As part of a routine lab panel, cholesterol is typically checked and often a source of discussion upon review. Many patients, understandably, are reluctant to start a cholesterol medication right away. Rather, I am often asked, “Can I just repeat the labs in 6 months? I’m going to work really hard on my diet!” And as I mentioned in previous posts, I am always willing to work with patients on non-drug therapies to address health concerns. But I think it’s also helpful to set expectations - how much can your diet affect your lab results? And is that really the outcome we should be aiming for?
When doctors make recommendations on starting a cholesterol medication like a statin, the results of the lipid panel blood test are only a part of that decision. Because while it feels nice to see no red on your lab results, it’s really a person’s risk of having a heart attack or a stroke that drives the decision to start medication. Sometimes I see a healthy 35 year old with a significantly elevated LDL (that’s the bad cholesterol) and I spend the visit talking about diet and exercise. Other times I see a 60 year old with high blood pressure and diabetes who smokes, and I’m bringing up cholesterol medication before I even see the blood test results.
This is because statin medications are all about risk reduction. If taking a statin reduces your risk of heart attack and stroke, but your risk as a 35 year old healthy person is super low, then you aren’t getting much benefit. But if your risk for heart disease is high, even if it’s based on factors like age or other health conditions besides cholesterol, then your benefit will also be high.
All patients, whether it’s the 35 year old with high LDL or 60 year old with high blood pressure, should focus on the impacts of diet on cholesterol. A sweeping diet change, such as adopting the Mediterranean or a vegetarian diet, can lower LDL cholesterol by about 20%, assuming you are changing from a pretty poor diet at baseline. It can be challenging to make such a drastic diet change, so I recommend starting small. Try to limit meat to lean products like chicken, turkey, and fish. Aim for one vegetarian meal per week, using tofu as a substitute. Opt for whole grain with your carb choices.
These smaller changes might not drop your LDL as much as you would like to see, but remember the ultimate goal here is to lower your risk of heart attack and stroke. So even if you still see some red on your lab report, don’t give up on your diet! These efforts are affecting that which matters most - your cardiovascular risks and overall health. With direct access primary care, we can work together to create a plan to make these lifestyle interventions successful for you!
