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Ask Dr. Gourmet

How can I improve my cholesterol scores without medication?

I am a 30-year veteran of the Army and in pretty good condition. I am active, no weight problems and (other than fried chicken) eat pretty reasonable meals. My big drawback is cholesterol. Mine has been as high as 285. My family has a history of high cholesterol.

I have tried every statin on the planet and have terrible reactions to them all. I have unbelievable muscle pains and had to be hospitalized after taking Pravachol. The doctors say this is rare. Right now I am not on any meds for the cholesterol. I am taking a few natural herbs like fish oil. What can I do that will help?

Dr. Gourmet Says...

a man jogging for exercise while wearing headphones

The most important consideration is your cholesterol profile. Occasionally I will have a patient who has been put on medication for a high cholesterol score, but their low density lipoprotein (LDL) cholesterol isn't putting them at high risk when other risk factors are taken into consideration. Family history, smoking, diabetes and hypertension play a role in evaluating such risk. We also consider weight (Body Mass Index), waist circumference, race, and activity level as well as stress. You can find out more about the types of cholesterol and recommendations in this informational handout. (PDF document.)

Problems with statins is a challenge that we face often. The statins that we use for folks with high cholesterol do come with side effects, including muscle aches as well as numbness. Fish oil has been shown to help improve lipid panels, especially in the case of high triglycerides, and there are other "natural" alternatives. We know that niacin is very effective, for example, but it carries many of the same risks and side effects of statins. Red rice yeast has a similar action as statins but is less well studied. (Note: Those on cholesterol-lowering medications who are interested in taking these supplements should discuss them with their own doctors before trying them.)

The key for you may be in both diet and exercise. We know that aerobic activity and weight loss can lower LDL (bad) cholesterol and raise the high density lipoprotein (HDL) cholesterol. Controlling BMI and the waist to hip ratio (WHR) can also have a positive effect on cholesterol profiles.

As far as diet, we know that a Mediterranean style diet can have a major impact on lowering LDL cholesterol and raising HDL (good) cholesterol. The key is not in eating a low cholesterol diet, as we once thought, but a diet that is low in saturated fat, especially the man made fats like hydrogenated oils and trans fats. Avoiding fast food, junk food and other processed food is very important. These are full of the "bad" fats and seldom have good monounsaturated fats. (Not to mention the tremendous amount of added salt.)

Snacking on fruits (if you like sweets) and nuts (if you are a savory snacker) also helps with cholesterol. Getting more fiber by eating more veggies, whole grains and legumes, as well as eating less meat and leaner meats can have a major impact. Eating fish that's high in Omega 3 fats has a similar (but probably more powerful) effect as the fish oil.

You can find info on getting started on why and how to follow a Mediterranean style diet in our section on The How and Why of Eating Healthy.

Great luck to you.

Thanks for writing,

Timothy S. Harlan, MD, FACP, CCMS
Dr. Gourmet