At 35, gastroenterologist Dr. Wu Tsung-Chin received a health screening result he did not expect: His low-density lipoprotein (LDL) cholesterol had reached 190 milligrams per deciliter, whereas a healthy person’s level should be 100 mg/dL or less.

The number was especially concerning because two relatives had died of heart attacks before age 70, while his father had hypertension and high cholesterol. Wu, an attending physician in the Department of Hepatobiliary and Gastroenterology at Po-Tien International Hospital, realized that his elevated LDL might reflect more than simply “eating too much oil.”

“The power of genes is greater than the power of acquired efforts,” Wu said on “Health 1+1” on NTD, a sister outlet of The Epoch Times.

After age 40, Wu began taking medication for his blood pressure and cholesterol. When he weighed between 189 and 191 pounds, his blood lipids remained difficult to control, and he also experienced mildly elevated liver enzymes and muscle soreness.

In recent years, he lost approximately 15 percent of his body weight. His blood pressure returned to normal, and he was able to manage his cholesterol with the lowest effective medication dose—but he still needed medication.

His experience illustrates an important distinction: Healthy habits can substantially reduce cardiovascular risk, but some people inherit a tendency toward very high LDL that diet and weight loss alone may not overcome.

When High Cholesterol Runs in the Family

An untreated LDL level around 190 mg/dL does not by itself confirm an inherited disorder. However, a result this high—especially alongside a strong family history—should prompt evaluation for familial hypercholesterolemia and other possible causes.

Familial hypercholesterolemia can keep LDL elevated from an early age, increasing the body’s lifetime exposure. The 2026 U.S. dyslipidemia guideline therefore emphasizes earlier identification and treatment. It also recommends measuring lipoprotein(a), or Lp(a), at least once in adulthood because this largely inherited marker may reveal additional cardiovascular risk.

If familial hypercholesterolemia is diagnosed, parents, siblings, and children should also be evaluated, according to the American Heart Association.

3 Dietary Priorities

People with high cholesterol are often told to avoid eggs and seafood first. Wu said it is more useful to consider the entire dietary pattern, particularly the types of fat and refined carbohydrates eaten regularly.

1. Avoid Industrial Trans Fats

Trans fats can raise LDL while lowering high-density lipoprotein (HDL), which helps transport cholesterol away from the arteries. Artificial trans fats have largely been removed from the U.S. food supply but may remain in some foods elsewhere. Possible sources include certain creamers, pastries, shortenings, fried foods, and packaged snacks. Consumers can check ingredient lists for partially hydrogenated oils.

2. Limit Fatty and Processed Meats

Bacon, sausage, hot dogs, fatty pork, and many deli meats can contain substantial saturated fat, which can raise LDL. Processed meats may also be high in sodium.

Rather than eliminating all meat, people can choose leaner cuts, keep portions moderate, and replace some meat with fish, beans, tofu, nuts, or other plant proteins. Replacing saturated fat with unsaturated fat—from foods such as fish, nuts, seeds, avocados, and olive oil—is more helpful than simply removing fat without considering what replaces it.

3. Limit Sugary Drinks and Desserts

Large amounts of added sugar, particularly from sweetened drinks, make it easier to consume excess calories and may contribute to elevated triglycerides and fatty liver. Wu therefore limits sugary beverages and desserts rather than focusing exclusively on foods that contain cholesterol.

What About Eggs and Seafood?

Egg yolks contain dietary cholesterol, but eggs also provide protein and essential nutrients. For many people, eggs can fit into an overall heart-healthy diet. People with very high LDL, however, may be advised to limit both saturated fat and dietary cholesterol, depending on their individual risk and the rest of their diet.

Shellfish such as shrimp and clams contain cholesterol but are generally relatively low in saturated fat when steamed, boiled, or grilled without large amounts of butter, batter, or creamy sauce.

Wu noted that some seafood organs, roe, and heads can be particularly cholesterol-rich. More broadly, the cooking method and the full meal often matter more than labeling all seafood as unhealthy. Fried shrimp with a heavy sauce has a very different nutritional profile from steamed shrimp served with vegetables.

A Simple Rule for Eating Out

Wu summarizes his approach to restaurant meals with three ideas: use less oil, choose minimally processed foods, and keep the proportions balanced.

That may mean choosing grilled, steamed, roasted, or braised dishes instead of fried ones; selecting lean protein; and filling more of the meal with vegetables, beans, and minimally processed whole grains. Sauces and dressings can be served on the side.

He does not believe healthy eating requires abstaining from every favorite food.

“Our bodies are actually quite flexible,” Wu said. “Small amounts of any food are OK—just don’t overdo it.”

Oatmeal Can Help—Modestly

Many patients ask Wu whether oatmeal can lower cholesterol. His answer is yes, but expectations should be realistic.

Oats contain beta-glucan, a soluble fiber that forms a gel-like material in the intestines. This helps trap bile acids made from cholesterol and increases their excretion. The liver then draws LDL from the blood to make more bile acids.

A meta-analysis published in The American Journal of Clinical Nutrition found that consuming at least 3 grams of oat beta-glucan per day reduced LDL by approximately 0.25 millimoles per liter—roughly 10 mg/dL—and modestly lowered total cholesterol.

The amount of oats needed to provide 3 grams varies by product. Plain rolled or steel-cut oats can be good choices, but some oat milks, granolas, instant products, and oat snacks contain added sugar or provide relatively little fiber. A product does not automatically become heart-healthy because “oat” appears on the package.

Most importantly, oatmeal is one useful part of an overall dietary pattern—not a substitute for medication when medication is medically indicated.

Medication Is Not an Addiction

Many people fear that once they begin cholesterol-lowering medication, their bodies will become dependent on it. Wu said this is not addiction. Medication controls an underlying problem while it is being taken. If the genetic tendency or disease state remains, cholesterol may rise again after treatment stops.

“Some people are not suitable to discontinue lipid-lowering medications on their own,” Wu said, particularly those who have already had a heart attack or stroke or have other major cardiovascular risks.

Treatment should nevertheless be individualized. A physician may consider a person’s LDL level and trend, family history, diabetes or kidney disease, previous cardiovascular events, response to treatment, and adverse effects. Anyone experiencing muscle pain or abnormal liver tests while taking a cholesterol-lowering drug should consult a clinician rather than stopping independently.

The 2026 ACC/AHA dyslipidemia guideline recommends LDL goals based on risk: below 100 mg/dL for borderline- or intermediate-risk primary prevention, below 70 mg/dL for high-risk primary prevention, and below 55 mg/dL for people with cardiovascular disease who face a very high risk of another event.

These are not targets people should choose for themselves. A clinician can determine the appropriate goal and the safest way to reach it.

Supplements Are Not Simple Substitutes

Some people hope to use fish oil or red yeast rice instead of prescribed medication. Fish oil primarily helps lower triglycerides, Wu said; it is not a reliable substitute for LDL-lowering treatment.

Some red yeast rice products contain monacolin K, a compound chemically identical to the prescription drug lovastatin. Products containing a meaningful amount may lower LDL, but they can also cause statin-like adverse effects and drug interactions. The amount of monacolin K in supplements varies widely, and labels often do not disclose it.

Do Not Wait for Symptoms

High cholesterol usually causes no obvious warning signs. “Many people experience their first attack as an acute myocardial infarction or sudden death,” Wu said.

People with markedly elevated LDL or a strong family history can ask their physicians whether they need earlier or more frequent lipid testing, evaluation for an inherited cholesterol disorder, and a one-time Lp(a) test. If an inherited condition is identified, screening close relatives may uncover risk before a heart attack or stroke occurs.

Wu could not change the genes he inherited. But by discovering his risk, losing weight, improving his habits, and using the lowest effective medication dose under medical supervision, he changed what those genes might mean for his future.