More than 38% of adult Americans and 7% of children and adolescents ages 6 to 19 are living with high cholesterol, according to the CDC. High cholesterol is linked to a host of concerning health conditions, including heart disease, high blood pressure, and stroke. According to Leslie Cho, MD, Section Head for Preventive Cardiology and Cardiac Rehabilitation at Cleveland Clinic, screening for high cholesterol should start at age 7. “We do not want to start children on cholesterol medication at that age, but rather to get them thinking about the importance of a healthy diet and regular exercise,” said Dr. Cho. “We think of heart disease as an old person’s problem but, really, prevention should start in childhood.”

All cholesterol is not created equal. “Overall, cholesterol is important for our bodies. We use cholesterol to do a variety of things,” says Kate Kirley, MD, director of chronic disease prevention at the American Medical Association. “Our body creates cholesterol whether we eat it or not and it’s good to have for certain functions within our bodies. But there are some types of cholesterol that are potentially helpful and protective. We usually think of HDL, or high-density lipoprotein, cholesterol as somewhat protective for our hearts and blood vessels because it absorbs cholesterol and carries it back to the liver. We tend to think of LDL cholesterol, or low-density lipoprotein, as the main type of cholesterol that we focus on as a potentially harmful cholesterol for our hearts because it collects in the walls of your blood vessels. [Triglycerides] are a type of fat or lipid that are most influenced by what we eat and they are closely related to cholesterol. Our triglyceride levels are changing throughout the day, and they can be a risk factor for heart attack and stroke.”

The good news? High cholesterol can be lowered or avoided altogether. “Heart disease is 90 percent treatable – everyone can prevent heart disease anywhere in the world, especially by eating foods that are low in salt and cholesterol, exercising regularly, and not smoking,” says Dr. Cho. “Even if a person has a family history of heart disease, we can still prevent and treat heart disease thanks to incredible advances in medicine.” Here are five ways you can reduce your cholesterol naturally, according to doctors. Read on—and to ensure your health and the health of others, don’t miss these Sure Signs You’ve Already Had COVID.

Regular exercise can help lower bad cholesterol. The Cleveland Clinic suggests brisk walks or jogging, cycling, swimming, and yoga as some exercises effective in lowering cholesterol and improving overall health. “The optimal goal is to achieve approximately 200 minutes per week of exercise,” Dr. Cho says. This means just a half hour walk or hike can have impressive health benefits.

The American Heart Association suggests doctors prescribe exercise for their patients who have elevated cholesterol. “The first treatment strategy for many of these patients should be healthy lifestyle changes beginning with increasing physical activity,” says Bethany Barone Gibbs, PhD. “In our world where physical activity is increasingly engineered out of our lives and the overwhelming default is to sit – and even more so now as the nation and the world is practicing quarantine and isolation to reduce the spread of coronavirus – the message that we must be relentless in our pursuit to ‘sit less and move more’ throughout the day is more important than ever.”

Chronic stress is linked to an increased risk of getting high cholesterol. Unchecked stress means increased cortisol, and increased cortisol can lead to high cholesterol. “Stress will make your cholesterol go up,” says Stephen Kopecky, MD, a preventive cardiologist at the Mayo Clinic in Rochester, Minn. “Without a doubt, that has been underrecognized.” Many people are not even aware that stress can lead to high cholesterol. “We don’t always have an optimal awareness of stressors we experience and the magnitude of those stressors,” says Catherine Stoney, program director in the division of cardiovascular sciences at the National Heart, Lung and Blood Institute, part of the National Institutes of Health.

“If you know what pushes your buttons, then avoid it. But there are stresses we have to accept, so we must change our reactions to them,” says Dr. Ann Webster, a health psychologist at the Benson-Henry Institute for Mind Body Medicine at Harvard-affiliated Massachusetts General Hospital. Dr. Webster suggests relaxation techniques such as meditation and yoga, cognitive behavioral therapy, and goal setting. “When people set goals for themselves, they have a positive sense of commitment, feel they’re in control, and are optimistic.”

Study after study seems to confirm the Mediterranean diet as being best for heart health, something many doctors recommend. “We can all benefit from a heart-healthy dietary pattern regardless of stage of life, and it is possible to design one that is consistent with personal preferences, lifestyles and cultural customs. It does not need to be complicated, time consuming, expensive or unappealing,” says Alice H. Lichtenstein, D.Sc., FAHA, senior scientist and director of the Cardiovascular Nutrition Team at the Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University in Boston.6254a4d1642c605c54bf1cab17d50f1e

“The standard American diet is full of refined, processed foods, and these types of foods significantly contribute to high cholesterol levels,” says Dr. Joshua Septimus, associate professor of clinical medicine and medical director of Houston Methodist Primary Care Group Same Day Clinics. “These are the foods you find in the inside aisles of grocery stores, such as packaged goods, frozen meals (although frozen fruit and veggies are fine!) and commercially baked snacks, as well as things like bacon and cured meats,” says Dr. Septimus, who recommends a diet focused on whole foods such as vegetables, fruits and unprocessed meats.

According to the CDC, smoking is responsible for 480,000 deaths annually, including deaths related to second-hand smoke. Aside from being absolutely terrible for your overall health, smoking helps raise LDL cholesterol and makes it stickier, and therefore more dangerous. Smokers are also two to four times more likely to have a stroke compared to non-smokers. While smokers are generally aware that the habit is bad for their lungs, doctors are worried that many smokers aren’t aware of the connection between smoking and heart disease. 

“We know that smoking is a risk factor for cardiovascular disease and that cessation leads to decreases in cardiovascular disease and the risk of death,” says Dr. Mayank Sardana, a cardiac electrophysiology fellow at the University of California San Francisco School of Medicine. “But only a minority of smokers are receiving counseling in cardiology clinics and assistance in trying to quit.”

“My experience has been that for cardiologists, tobacco has sort of been the forgotten risk factor,” said Dr. Nancy Rigotti, a professor of medicine and internist at Harvard Medical School and Massachusetts General Hospital.

Being obese or overweight carries many health risks, not least the increased risk of high LDL cholesterol. “Excess body fat has serious consequences for health. It’ associated with high levels of LDL (‘bad’) cholesterol and triglycerides and low levels of HDL (‘good’) cholesterol,” says Harvard Health. “It impairs the body’s responsiveness to insulin, raising blood sugar and insulin levels. Excess body fat contributes to major causes of death and disability, including heart attacks, strokes, high blood pressure, cancer, diabetes, osteoarthritis, fatty liver, and depression.”

“Bouncing your weight up and down may even put you at greater risk for heart disease,” is the advice Joseph S. Alpert, MD, gives his patients. “Regular exercise such as daily walking is a great help in losing weight. Try to cut back on portion size, simple carbohydrates such as sugar and products made with white flour, as well as saturated fat in your diet… It is important that modest weight loss in an obese patient with atherosclerotic risk factors can result in remarkable improvement in these risk factors. Indeed, it has often been observed that modest (∼10% of body weight) loss of weight produces marked amelioration in elevated blood pressure, abnormal serum cholesterol, and glucose intolerance.”