Is It Possible to Manage High Cholesterol Without Medication?

Living with familial hypercholesterolemia (FH) can feel like a roller coaster. There are many bumps that are faced when figuring out the best course of treatment. As an FH warrior who’s been there — trying everything under the sun to manage my cholesterol naturally — I can say that with empathy.

Spoiler alert: Despite all my efforts with diet, exercise, and lifestyle changes, I couldn’t do it.

What's different about genetically high cholesterol?

First thing's first: What exactly is FH? It’s a relatively common condition that many don’t know they even have. It’s a genetic condition that causes your body to have high levels of low-density lipoprotein (LDL) cholesterol, also known as "bad" cholesterol. Unlike others who have high cholesterol due to lifestyle or poor diet, people with FH have an inherited condition that makes it tough for their bodies to clear out LDL cholesterol from the blood. This can lead to dangerously high cholesterol levels, even from a young age, putting us at a much higher risk for early heart attack, heart disease, and stroke.¹

What I tried when going the 'natural route'

When I first found out I had FH at age 18, I was all-in on the idea of managing it naturally. I overhauled my diet, prioritizing heart-healthy foods like fruits, veggies, whole grains, and lean proteins. I stayed away from saturated fats, trans fats, and cholesterol, and I made sure to pack in fiber whenever I could. On top of that, I made exercise a regular part of my routine — my go-to activities being Zumba, sculpt, and HIIT — sometimes even 2-a-days.

These lifestyle changes were great for my overall health; they made a noticeable difference in how I looked and felt. But when it came to my LDL cholesterol levels, it didn't solve the problem. My LDL decreased by 100 points, but it was STILL stubbornly high, which, as it turns out, is very common for people with FH. No matter how healthy your habits are, the genetic nature of FH makes it resistant to natural interventions alone.

Why medication is part of FH treatment plans

Here’s the thing about FH: because our bodies struggle to clear out LDL cholesterol, even the healthiest lifestyle might not be enough to get those levels down to where they need to be. That’s where medication comes in.

Statins, for example, are often prescribed to help lower cholesterol by blocking an enzyme in the liver responsible for making cholesterol. There are also other medications, like PCSK9 inhibitors (my favorite of these has been Repatha so far), that can be added to the mix to give your cholesterol levels an extra push in the right direction, or they can be used on their own if you are statin-intolerant or contraindicated (like me!).²

Lifestyle changes alone weren't enough, but they help

Realizing that lifestyle changes alone aren’t enough was tough for me. It’s easy to feel like I’m not doing enough or that I’ve somehow failed or am broken. But it’s important to remember that FH is a genetic condition, and sometimes, medicine is simply part of the equation to keep my heart safe!

Even though medication is most likely necessary for those of us with FH, it doesn’t mean we should toss out our healthy habits. In fact, combining medication with a heart-healthy lifestyle is the best way to manage FH. Eating well, staying active, managing stress, and getting enough sleep all play important roles in your overall health, and they can make our medication even more effective.

A combined treatment approach makes all the difference

So, is managing high cholesterol without medication possible? For those of us with FH, the answer is often "No." And that’s okay! It doesn’t mean we’re not doing enough. It just means that FH is a tough condition that needs all the tools we can give it — healthy habits, yes, but also the right medication to keep our cholesterol levels in the safe zone.

Living with FH definitely isn’t easy, but with the right approach, it’s totally manageable. Working with your healthcare team to find the best combination of lifestyle changes and medication is the key to keeping your heart healthy.

And remember, medication isn’t a sign of defeat; it’s a vital part of taking control of your health and living your best life!