Borderline cholesterol on a checkup

What does borderline cholesterol mean?

A routine blood test, called a lipid panel, measures total cholesterol, LDL (“bad”) cholesterol, HDL (“good”) cholesterol and triglycerides. MedlinePlus lists an LDL level of 130 to 159 mg/dL as borderline high, 100 to 129 mg/dL as near optimal and under 100 mg/dL as optimal for most adults (MedlinePlus). A borderline result is not a diagnosis of disease. It is a signal to look at your overall heart risk, which also depends on age, blood pressure, smoking, diabetes, family history and other factors.

High cholesterol usually causes no symptoms at all, which is why testing matters. The National Heart, Lung, and Blood Institute notes that genes, diet, physical activity, weight and some medical conditions all affect cholesterol levels (NHLBI).

Start with lifestyle

Food choices

Diet is the first lever. MedlinePlus recommends a heart-healthy eating pattern that limits saturated and trans fats, since these raise LDL cholesterol (MedlinePlus). In practice that means less fatty red and processed meat, butter, full-fat dairy and baked goods, and more vegetables, fruits, legumes, whole grains, nuts and fish.

Soluble fiber deserves special mention. A meta-analysis of randomized trials found that 3 grams or more a day of oat beta-glucan lowered LDL cholesterol by about 0.25 mmol/L, roughly 10 mg/dL, with bigger drops in people who started higher (Whitehead et al., 2014). Oatmeal, oat bran, barley, beans and psyllium are practical sources. Our post on soluble vs. insoluble fiber explains the difference.

Movement and weight

Regular physical activity can lower LDL cholesterol and triglycerides and raise HDL (MedlinePlus). Brisk walking most days counts. If you carry extra weight, losing even a modest amount can improve your numbers. Not smoking and limiting alcohol also help heart health overall.

Recheck and talk about risk

Ask your clinician when to repeat the test and whether your overall risk calls for medication. For people at higher risk, statins and other prescription drugs have strong evidence for reducing heart attacks and strokes, which no supplement can claim.

What about supplements?

Supplements should come after, not instead of, these steps. Soluble fiber supplements such as psyllium have the most consistent evidence for modest LDL reductions. Other popular options are less convincing. Reishi mushroom, for example, did not lower cholesterol in a Cochrane review of trials in people with diabetes (Klupp et al., 2015), and most other mushroom extracts lack human cholesterol trials. See our reviews of reishi, shiitake and Cholibrium.

Some products can act like drugs. NCCIH warns that red yeast rice products may contain monacolin K, which is chemically identical to the statin lovastatin, so they can carry the same side effects and drug interactions, and the amount varies widely between products (NCCIH). High-dose niacin also changes cholesterol levels but has real side effects and should only be used under medical supervision.

Before trying any supplement for cholesterol, tell your doctor, especially if you take statins, blood thinners, diabetes or blood pressure medicines, or are pregnant.