The role of exercise and diet in managing cholesterol

Managing cholesterol levels is crucial for maintaining heart health and preventing cardiovascular diseases. Cholesterol, a type of lipid found in the blood, is critical in maintaining cell structure, producing hormones, and supporting overall cellular health. 

However, Brenda Rea, MD, DrPH, PT, RDN, DipABLM, and Lifestyle Medicine Intensivist at Loma Linda University Health, emphasizes the severe consequences of high cholesterol. "Excessive cholesterol can accumulate in your arteries, leading to blockages that significantly increase the risk of heart attacks and strokes as well as increase the risk of complications from diabetes,” she warns.  

Fortunately, one of the most effective ways to maintain healthy cholesterol levels is to adopt a healthy lifestyle, with exercise and diet being powerful and natural methods to keep cholesterol in check.

Understanding Cholesterol

When a person has their cholesterol levels checked via a blood test, the lipid panel measures several components: total cholesterol, low-density lipoprotein (LDL), high-density lipoprotein (HDL), and triglycerides. Rea says it’s important for patients to understand what each component means.

Total cholesterol

Refers to the combined amount of cholesterol present in your blood.

LDL

Often referred to as "bad" cholesterol — or as Rea calls it, "lousy" cholesterol — LDL carries cholesterol to various tissues throughout the body. When LDL levels are too high, it can lead to plaque buildup in the arteries, causing them to narrow and harden.

Excess LDL can accumulate in the endothelial layers –– the cells lining the blood vessels and lymphatic system –– leading to blood vessel dysfunction. This dysfunction is a significant contributor to vascular diseases, including heart attacks, strokes, brain disorders, peripheral vascular disease, and more. 
 
HDL 

Often referred to as "good" cholesterol — or as Rea calls it, "happy" cholesterol — HDL plays a crucial role in maintaining cardiovascular health. It helps remove LDL cholesterol from the bloodstream by carrying it back to the liver, where it can be processed and eliminated from the body. 

Higher levels of HDL are associated with a lower risk of heart disease because HDL acts as a carrier to eliminate LDL from the body, which helps balance cholesterol levels. By transporting excess cholesterol out of the body, HDL helps prevent harmful cholesterol buildup and supports overall heart health.

Triglycerides

Triglycerides are the most common fat in the blood and a major energy source. When you eat, your body converts any calories it doesn't need to use right away into triglycerides, which are then stored in fat cells. Later, hormones release these triglycerides for energy between meals. Two major contributions to elevated triglyceride levels include consuming processed and refined foods and drinking alcohol. 

How exercise affects cholesterol

While exercise does not have a substantial effect on LDL, it does play an important role in influencing HDL cholesterol. Since HDL lowers LDL, Rea says it’s important to drive HDL high through exercise to keep LDL lower. Ideally, the best exercises for raising HDL include movement that falls under cardiorespiratory or aerobic fitness, such as:

• Running

• Cycling

• Swimming

• Brisk walking

• Rowing

• Jump Rope

• Elliptical training

Rea also recognizes the value of strength training exercises in building muscle mass. 

"The more muscle mass you have, the more calories you burn all day, even at rest, as your metabolic rate increases,” Rea says. “Men, due to higher testosterone levels, can build muscle mass more easily than women. Simple home resistance training, like squats, lunges, push-ups, and pull-ups, can be a good place to start when considering a strength training program."

How diet affects cholesterol

To lower cholesterol levels through diet, adopting a two-pronged approach is crucial: reduce intake and enhance elimination. When considering nutrition and its impact on cholesterol, Rea emphasizes the importance of reducing dietary cholesterol intake. 

“Your body naturally produces cholesterol, so consuming foods high in cholesterol can contribute to elevated levels,” Rea says. “The first step in managing cholesterol through diet is to minimize or eliminate cholesterol-rich foods to lower LDL levels effectively.”

A fiber-rich diet, particularly from plant-predominant sources, is the most effective way to achieve this. Fiber in unprocessed plant foods binds with cholesterol in the digestive system, helping to remove it from the body before it can be absorbed into the bloodstream. Therefore, increasing your consumption of fiber-rich foods is essential for promoting cholesterol excretion.

When deciding what to eat, a whole-food, plant-predominant diet is particularly beneficial due to its high fiber content. Such a diet not only helps lower cholesterol but also supports overall health by providing nutrient-dense foods rich in fiber and water. 

“This type of eating pattern naturally encourages satiety, helping you regulate food intake according to hunger cues, which can aid in weight loss — a key factor in cholesterol management,” Rea says.

However, many people struggle with disrupted hunger and satiety signals, often eating for reasons other than physical hunger. Processed foods, including many fast and frozen foods, are often highly addictive, which can further complicate this issue. 

“Focusing on a nutrient-dense, plant-predominant diet can lower cholesterol levels and achieve a healthy weight, which contributes to better cholesterol management,” Rea emphasizes. 

Lifestyle adjustments to lower cholesterol 

Often, someone with high cholesterol doesn’t feel any symptoms. It’s easy to associate feeling well with being healthy, and therefore have less incentive to make necessary lifestyle changes. However, Rea warns that if an individual feels healthy but has high cholesterol, they are still at risk for serious health complications. 

"When working with patients who have high cholesterol, I remind them that even if they feel fine now, high cholesterol can lead to serious conditions like heart disease, stroke, and increased risk of complications from diabetes," Rea says. "While they may feel healthy today, there will come a time when the body becomes less resilient. Understanding these risks can empower individuals to make meaningful changes to their diet and fitness habits.”

Early detection of high cholesterol can make a significant difference. Preventative and Lifestyle Medicine specialists at the Center for Health Promotion can provide individualized lifestyle treatment to prevent, treat, and reverse excess cholesterol as steps toward a healthier future.