What to Eat When You Have High Cholesterol

Managing your high cholesterol (hypercholesteremia) will likely involve a multi-strategy approach, and a diet specifically designed to lower your cholesterol levels is an important one. Advice about what that looks like has changed a bit over the years and, today, it's believed that the foods you choose to eat may matter just as much as (or perhaps more than) those you avoid.

The more high-density lipoprotein (HDL) you have, the more cholesterol your body can remove from your blood. The more low-density lipoprotein (LDL) you have, the more plaque buildup (atherosclerosis) is likely to occur. The diet recommended to you when you have high cholesterol, then, will involve foods that help increase the former (what's often called "good cholesterol") and decrease the latter (a.k.a., "bad cholesterol"). And perhaps surprisingly, fats and carbohydrates, rather than dietary cholesterol, will be the main focus.

Your body needs cholesterol for several functions, including forming protective membranes for cells and producing bile to help digest food. Cholesterol is also used to make vitamin D and hormones like estrogen and testosterone. While diet (meat, eggs, dairy) is a source, cholesterol is also naturally present, as it is made by your liver.

Cholesterol plays an important role in your health, but an imbalance of HDL and LDL is of concern. The more HDL you have, the more cholesterol your body can remove from your blood. But if you have a lot of LDL, plaque build-up (atherosclerosis) is more likely to happen, which can lead to heart disease and stroke.

Triglycerides, another type of lipid, are fats that you get from your diet that circulate in your blood. Alcohol, sugar, and excess calories are also converted into triglycerides and stored in body fat. They are also important to note, as they can influence cholesterol levels as well.

The diet's biggest benefit can be summed up by the simple fact that it helps give you some ability to manage a condition that has several unmodifiable risk factors, such as family history, age, and sex. The plan takes all of these factors—HDL, LDL, and triglycerides—into account to restore the balance that your body needs to both function and reduce your risk of coronary artery disease (CAD) and other heart diseases.

Fat and carbohydrates in your diet, in combination, are the biggest dietary influences on your cholesterol levels. A diet for high cholesterol focuses on these elements, as well as reducing dietary cholesterol, even though it is not considered as influential as it once was.

Much of the old wisdom on foods to avoid if you have high cholesterol is no longer considered to be accurate, which can lead to some confusion. A well-known example is eggs.

For many years, eggs were believed to raise cholesterol levels and people with high cholesterol were advised to avoid them. However, recent research has found that eggs don't have a major influence on cholesterol. In fact, many of the nutritional benefits of eggs can be helpful to people trying to manage their cholesterol with diet. 

The fact that all fats are not equal plays a role here, too. While saturated fats can negatively affect lipid levels (specifically, LDL), healthy fats, such as those found in nuts and avocado, can help lower cholesterol levels by boosting your HDL.

Although you can make decisions about your diet, you can't control how your body responds to cholesterol in the food you eat.

Research has indicated that some people are naturally more sensitive to it than others, and the cholesterol levels of “responders” are more influenced by diet than those of "non-responders." For people who aren't as sensitive, what they eat doesn't influence their levels much (if at all).

There are several treatments for high cholesterol and you may need to simultaneously use more than one to get your levels down and keep them in a healthy range.

When you're thinking about how much cholesterol is in your diet, remember that your body makes its own supply—and it will provide what you need, despite your diet. As such, there isn't a set amount of cholesterol you need to get from the food you eat.

In the past, the general recommendation was 300 milligrams (mg) of dietary cholesterol (or less) per day. However, in 2018, the American Heart Association guidelines for dietary cholesterol intake were changed.

Most adults, whether they have high cholesterol or not, are advised to keep dietary cholesterol intake low while still eating a varied, balanced, and “heart-healthy” diet, but adherence to these guidelines is especially important if you've been prescribed a diet for high cholesterol.

Your doctor may make more specific recommendations for you based on your overall health (for example, if you have other chronic health conditions or risk factors for heart disease).

Once you've made changes to the way you eat to help manage your cholesterol, you’ll likely need to keep those changes long term; going back to your previous diet may encourage your levels to rise again.

Given this, it may help to think about your new way of eating as a permanent lifestyle modification rather than a temporary diet.

Focus on foods high in soluble fiber, phytosterols, and protein. Swap foods high in saturated or trans fats for those with unsaturated fats.

Fruits and vegetables: Plants don’t contain any dietary cholesterol, so you won’t have to limit fruits and vegetables in your diet. Aside from being nutritious, fruits and veggies are also packed with fiber and phytosterols—healthy chemicals that help you to keep your LDL levels in check.

Salads are typical go-tos, but be mindful of what you top them with. To give a salad lipid-lowering power, skip the dressing and extras like bacon, and go for a mix of leafy greens, lean protein, and seeds.

Grains: Soluble fiber can reduce the amount of cholesterol you absorb and lower LDL. Whole-grain foods (breads, flours, rice) are typically higher in fiber than their refined counterparts; oats and oat bran are particularly great choices.

However, check food labels for the fiber content and total carbohydrate content, since some already-prepared grains may contain added sugars.

Protein: You can eat meat on a lipid-lowering diet, just be careful about the types that you include. While the recommendations have long been to avoid red meat and choose lean white meat instead, a 2019 study published in the American Journal of Clinical Nutrition found that red meat and white meat didn't differ much in terms of how they affected cholesterol levels.

Fish such as halibut, tilapia, and cod are low in fat and carbohydrates and high in protein. Tuna and salmon also contain omega-3 fats, a type of healthy fat that has been shown to help reduce triglyceride levels.

Studies have shown nuts, seeds, and oils that are high in linolenic acid can reduce lipid levels. Walnuts, pecans, almonds, and pistachios are high in omega-3 fats and fiber. However, keep in mind that these foods are high in calories, so you’ll want to include them in moderation. 

Legumes such as beans are high-protein, low-fat foods that can have a powerful impact on your lipid levels. Not only are they versatile and nutritious, but the protein they contain tends to be filling. Most legumes have a fairly neutral taste and are suitable for different dishes, including soups, salads, sides, dips, and entrées.

Dairy: Choose non-fat milk and yogurt rather whole milk. Cheese is generally high in saturated fat, but small portions of low-fat cheese such as mozzarella are healthy choices. Single-serve cheese slices or sticks work well, especially as a quick snack. 

Dessert: Avoid sweets made with full-fat milk, butter, and sugar. Many packaged cakes, cookies, and snacks contain trans fats, which can raise “bad” cholesterol and lower “good” cholesterol. Instead, bake your own low-cholesterol desserts using fruit, egg whites, and oats. 

Beverages: Herbal tea, especially green tea, may help lower cholesterol. Citrus juice may also have a beneficial impact on cholesterol levels. Alcoholic beverages, especially mixed drinks and cocktails, can be sources of extra calories and sugar, and increase triglycerides.

In 2019, researchers reviewed the findings from the Nutrition and Health Survey in Taiwan to see if the timing of meals had any specific impact on cholesterol levels. 

The research indicated people who ate more at night may have higher LDL cholesterol levels than people who ate most of their food during the day. 

When these individuals consumed what would normally be their late-day calories earlier in the day instead, they had lower cholesterol levels. 

Another group of researchers looked at whether skipping meals had an effect on cholesterol levels. The research found people who skipped breakfast had higher LDL cholesterol, and people who skipped dinner had more triglycerides and a higher ratio of total and HDL cholesterol. 

As you’re preparing meals, you can reduce the fat content of meat by: 

• Selecting lean cuts of meat with no visible fat
• Trimming remaining fat or gristle from meat and removing the skin before serving
• Grilling, broiling, or roasting meat rather than frying it with high-fat butter or oil

With fruits and vegetables, avoid adding salt, sugar, butter, or canola oil, which are high in trans fats. To avoid diminishing their nutritional power, avoid adding any sweet sauces, fat, or grease to beans and legumes.

Instead, add flavor with spices. Aside from being tasty, many popular herbs and spices have properties that can change how LDL cholesterol interacts with free radicals—particles that can make the molecules in LDL unstable, causing inflammation and further impacting your cardiovascular health. The antioxidants in some fresh herbs and spices have been shown to prevent these damaging interactions. Garlic is another healthy and versatile option for savory meals that can help lower cholesterol and triglyceride levels. 

When baking, try adding ginger, allspice, and cinnamon, all of which are high in antioxidants. Instead of making baked goods using lard, butter, or oil, try using substitutes like applesauce, banana, or even avocado. 

Again, the diet recommended for you will be tailored to your condition and overall health profile. Your doctor may suggest a more strict plan for you, for example, if you have several compounding risk factors at play.

Even still, sometimes changing how you eat may not be enough to lower your cholesterol. Adding other lifestyle modifications like increasing your physical activity and losing weight may also prove insufficient.

If your levels are still high on a low cholesterol diet, your doctor may prescribe statins, medications that would be taken as you continue on with your diet for high cholesterol.

If you’re planning to make changes to your diet, it’s important to consider all the different parts of your life that might be affected. Your lifestyle, responsibilities, and preferences also influence your ability to make (and stick to) the changes you make. 

Compared to diets that heavily restrict which foods you can eat, a diet for high cholesterol can be quite varied and balanced. Fresh produce, lean meats, and low-fat dairy are all approved on this plan and part of a healthy diet for anyone.

Many of the foods you may want to avoid or limit on a low-cholesterol diet are high in fat, sugar, and calories. Choosing not to include these foods in your diet (or having them only in moderation) can have health benefits beyond managing cholesterol, such as helping you lose weight or lower your blood pressure. 

Though you may need to expand your typical shopping list and modify some favorite recipes, the wide range of foods that are appropriate on a diet for high cholesterol make the plan quite flexible.

Many restaurant menus highlight heart-healthy or low-fat selections, which may be appropriate. You can also ask to make simple swaps like a whole-grain wrap instead of a bun, or grilled chicken instead of fried.

If you’re not sure how to make your dietary needs and preferences work with a low-cholesterol diet, you may want to talk with a registered dietitian or nutritionist. They can guide you through creating a lipid-lowering meal plan. 

Such advice can be particularly helpful if you are also managing a gastrointestinal concern that is worsened by fiber/roughage or you need to avoid gluten (millet, teff, and quinoa are choices that are safe and packed with fiber).

By itself, a cholesterol-lowering diet shouldn't have any side effects. Whenever you make changes to how you eat, it's possible you will experience temporary bowel symptoms such as constipation, but these are usually temporary and get better as you adjust.

If you are starting a cholesterol-lowering drug as well, remember that any side effects you experience could also be the result of your medication. For example, muscle pain and weakness are common side effects of statins. Speak to your doctor about anything you're experiencing that is of concern.

The foods recommended to manage high cholesterol offer a myriad of other health benefits. Two in particular—helping you maintain a healthy weight and improving your energy—can make other changes, like exercising more, easier to adopt.

This can obviously help your cholesterol-lowering efforts, but it will also help reduce your risk of issues beyond cardiovascular ones, including cancer.

Choosing to eat a heart-healthy diet full of fresh produce, whole grains, and lean protein while avoiding foods that are heavily processed and high in trans fat can improve your cholesterol and triglyceride levels and may even help you address other risk factors for heart disease, such as your weight. You’ll want to discuss the different cholesterol-lowering approaches with your doctor. While making changes to your diet can help, you may also need medications to help get your levels under control.