What to Eat When You Have High Cholesterol

Having high cholesterol (hypercholesterolemia) increases your risk for many health problems, including heart disease. Cholesterol levels are affected by many different factors, some of which you don’t have control over (like genetics). However, there are some changes you can make that can help you manage your cholesterol better.

If your levels are elevated, your doctor may suggest a low cholesterol diet. Before you start, it will be helpful to understand how the food you eat can lower or increase the different types of cholesterol in your body.

Everyone’s body handles cholesterol in food differently. Your body may be more sensitive to it or not very sensitive at all. Research has indicated the cholesterol levels of “responders” are more easily influenced by dietary cholesterol compared to other people. 

If your cholesterol levels are high your doctor will probably have you try making changes to your diet to see if it will help. For example, a diet with less meat and more produce has been shown to help lower cholesterol levels in some people. 

Your doctor can find out what your cholesterol levels are with a set of blood tests called a lipid panel. The test measures both your LDL and HDL levels, which are used to calculate your total cholesterol, as well as your triglycerides. Having high levels of lipids is called hyperlipidemia. 

Since the body makes cholesterol, there isn’t a set amount adults need to get from the food they eat. In the past, the general recommendation was 300 milligrams of dietary cholesterol (or less) per day. 

However, in 2018, the American Heart Association guidelines for dietary cholesterol intake were changed. Most adults will simply be advised to keep their dietary cholesterol intake low while still eating a varied, balanced, and “heart-healthy” diet. 

Your doctor will likely make a specific recommendation for you based on other health factors, including your risk for heart disease. 

The fat carried by your blood cells, called triglycerides, can also influence cholesterol levels. If you have a high level of triglycerides in your blood it can contribute to the formation of plaques in your arteries. 

In fact, the combination of fat and carbohydrates in your diet are the biggest dietary influences on your cholesterol levels. 

Cholesterol is a substance made by the liver. Your body needs cholesterol for several functions, including forming protective membranes for cells and produce bile to help digest food. Your body also uses cholesterol to make vitamin D and hormones like estrogen and testosterone. 

Your body can make more than enough cholesterol to perform the jobs it needs to do, but you also get cholesterol from the food you eat. Dietary cholesterol is found in foods that come from animals, such as meat, eggs, and dairy. 

Cholesterol particles are waxy and don't dissolve in water or blood. The only way cholesterol can move through your bloodstream is by forming packages called lipoproteins. 

There are two forms these cholesterol packages can take: low-density lipoprotein (LDL) and high-density lipoprotein (HDL). 

When talking about diet, you’ll often hear cholesterol types referred to as “good” (HDL) and “bad” (LDL). Your body uses both lipoproteins but needs to maintain a certain balance. 

Cholesterol leaves your liver on low-density lipoproteins which carry it through your blood to your body’s tissues. When it’s time to return to the liver to be broken down and removed, the high-density lipoproteins pick up cholesterol and carry it back. 

The more HDL you have, the more cholesterol your body can remove from your blood. On the other hand, if you have a lot of LDL, you’re more likely to develop plaque buildup. 

If you have too much cholesterol in your bloodstream, it can build up and harden into plaques (atherosclerosis). Having plaques in your arteries makes it harder for blood to move through them. 

When blood circulation is reduced by plaque buildup, your risk of having a heart attack or stroke increases. You may also be more likely to develop other forms of heart disease or peripheral artery disease. 

Doctors typically recommend you start having your cholesterol levels checked in your early 20s. Most people can have them tested every 5 years. If you have high cholesterol or risk factors for heart disease, your doctor may want to check your levels more often. 

You don’t have to wait for your doctor to tell you your cholesterol is high before making changes to your diet. In fact, eating a heart-healthy diet while your cholesterol levels are still within the normal range may help keep them there. 

Once you’ve changed the way you eat to help manage your cholesterol, you’ll want to think about it more as a lifestyle change 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.

When you’re preparing fruits and vegetables, avoid adding salt, sugar, butter, or canola oil, which are high in trans fats.  

Grains: Whole grain foods are typically higher in fiber than their refined counterparts. There are many types of whole grains available, so it is fairly easy to experiment with them in your healthy meals. 

Many types of pre-packaged, whole wheat or whole grain flour or rice are also high in fiber, as they have not been processed in comparison to carbohydrates such as all-purpose flour or white rice. However, check food labels for the fiber content and total carbohydrate content, since some already-prepared grains may contain added sugars.

Protein: You can meat on a lipid-lowering diet, just be careful about the types of meat that you include. Lean protein sources such as turkey, soy, or chicken are your best bet when looking for meat to include in your heart-healthy diet, as these options typically contain less saturated fat and calories than fatty meat.

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.

Bake, grill, or lightly sauté your fish. Frying fish adds calories and unhealthy fats.

Walnuts, pecans, almonds, and pistachios are high in omega-3 fats as well as fiber. Studies have shown nuts, seeds, and oils that are high in linolenic acid can reduce lipid levels. 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 tends to be filling. 

Most legumes have a fairly neutral taste and are suitable for different dishes, including soups, salads, sides, dips, and entrees. To avoid diminishing their nutritional power, avoid adding any sweet sauces, fat, or grease. These additions easily increase the calorie content of an otherwise low-calorie protein source. 

Dairy: Choose non-fat milk and yogurt rather than those made with whole milk. Be mindful of your intake of cheese, which is generally high in saturated fat. Stick to small portions of a low-fat cheese such as mozzarella. 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. While alcoholic beverages such as wine and beer don’t contain cholesterol, mixed drinks and cocktails often contain ingredients that do. 

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 meals during the day. 

When these individuals took their late afternoon or nighttime calories and ate them earlier in the day instead, it was associated with 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. 

Aside from being tasty, many popular herbs and spices have properties that can change how LDL cholesterol interacts with other particles called free radicals. 

If free radicals make the molecules in LDL cholesterol unstable, it can cause inflammation. Increased inflammation in your body can contribute to the development of atherosclerosis and can have a negative effect on your overall cardiovascular health.  

The antioxidants in fresh herbs like cilantro, oregano, and dill have been shown to prevent damaging interactions between LDL and free radicals. 

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. 

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

• Selecting lean cuts of meat with no visible fat
• Trim remaining fat or gristle from meat and remove the skin before serving
• Grill, broil, or roast meat rather than frying with high-fat butter and oils

Sometimes changing how you eat, increasing your physical activity levels, and losing weight may not be enough to lower your cholesterol because the levels are determined by other factors as well. 

Genetics, how old you are, your biological sex, any medications you take, and other medical conditions you have also influence cholesterol levels. Unlike your diet, these are not necessarily factors you can easily control or change. 

If your levels are still high on a low cholesterol diet, your doctor may prescribe a type of medication called statins. 

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. 

General Nutrition

Compared to diets that heavily restrict which foods you can eat, a low cholesterol diet can be quite varied and balanced. Fresh produce, lean meats, and low-fat dairy are all part of a nutritious diet. 

Many of the foods you may want to avoid or limit on a low-cholesterol diet are high in fat, sugar, and calories. Packaged snacks and fast food also tend to be high in trans fat. 

Choosing not to include these foods in your diet (or having them only in moderation) can have other health benefits as well, such as helping you lose weight or lower your blood pressure. 

Most of the health risks associated with cholesterol occur when levels are high. While it doesn’t happen often, it is possible to have cholesterol levels that are too low (hypolipidemia). Very low lipid levels are usually caused by genetics, some health conditions, or medications used to help reduce cholesterol. 

If your cholesterol levels are too low, you may not have symptoms. Often low levels are discovered when you have a blood test as part of a routine exam or during treatment for another health condition. 

Some research has indicated very low levels of cholesterol may increase the risk of health problems for certain people, such as those who are pregnant. 

If you’re otherwise healthy, it’s not likely to have lasting negative effects on your health. You’re more likely to experience health issues related to very low cholesterol levels if you’re sick from another illness, such as cancer or liver disease.  

You can enjoy a wide selection of foods while following a diet to lower your cholesterol and triglycerides. When you’re shopping and cooking meals at home, you’ll be able to choose lipid-lowering foods. 

You can also make healthy choices if you’re dining out on a low-cholesterol diet. It’s even possible to find low-cholesterol fast food. Look for whole-grain veggie wraps instead of fried food.

Be careful when choosing greens: fast food salads can be among the highest calorie and highest fat items on the menu. To give a salad lipid-lowering power, skip the dressing and any extras like bacon and go for a mix of leafy greens, lean protein, and even fruit. 

If you follow a special diet due to a medical condition, food allergies, or personal preference, you’ll want to keep that in mind when you start a low-cholesterol diet. 

People who adhere to a plant-based diet may already be eating according to a low-cholesterol plan. If you do consume animal products, consider eating them less frequently. When you do have a steak or chicken breast, use heart-healthy cooking methods and keep portions small. 

If you have Celiac disease and need to avoid gluten, look for gluten-free whole grains that are packed with fiber, such as millet, teff, and quinoa. 

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. 

When combining a low-cholesterol diet with medication to reduce lipid levels, you may notice a change in how you feel. Any time you make changes to your diet and lifestyle, it can take some getting used to (physically and emotionally). 

Additionally, the drugs most commonly prescribed to treat high cholesterol (statins) can have side effects such as muscle pain and weakness.  

Some people experience elevated levels of enzymes in their liver when they take statins. You may not feel any symptoms, but the increased levels would show up on a blood test. 

Your doctor will monitor these levels while you are taking medication for high cholesterol to see if your medication dose needs to be adjusted. 

In addition to making changes to your diet, your doctor might encourage you to make other changes to your lifestyle to help lower your cholesterol. 

Losing weight, quitting smoking, and getting more exercise can help lower your lipid levels as well as improve your overall fitness and wellbeing. 

If you’ve already started eating more heart-healthy foods, you may feel like you have more physical and emotional energy to invest in making changes in other areas of your life. 

Committing to these changes will impact more than your cholesterol levels: you’ll also be reducing your risk of heart disease, stroke, and even cancer. 

There are many different diets that may be able to help you manage your cholesterol. While they have some similarities, there are some key differences you’ll want to be aware of. Your doctor can help you determine which diet is the best fit for you. 

Low-Carb Diet

While you might expect to go on a low-fat diet if you have elevated cholesterol, your doctor might recommend you try a low-carb diet to get your levels into a healthy range. Research has shown low-carb diets can actually be more effective at lowering HDL cholesterol than low-fat diets. 

One reason a low-carb diet can help lower your cholesterol is that when your body is not using carbohydrates for energy, it has to use stored fat. When your body uses up more stored fat, your triglyceride levels are likely to decrease as lipids are released. 

A low-carb diet can also help you lose weight and manage your blood pressure—both of which will have a positive impact on your cholesterol levels. 

The Mediterranean Diet is a way of eating that follows the dietary habits and cuisine of people living in Greece and throughout the Mediterranean region. The diet focuses on fresh produce, whole grains, olive oil, and legumes while limiting meat and dairy. 

The Meditteranean Diet is a popular option for people looking to lower their cholesterol levels, as the diet has been linked to a reduced risk of heart disease. Eating small portions of dairy products and choosing lean meat are eating habits that align with cholesterol-lowering diets. 

If you don’t eat animal products or are planning to stop eating them to help manage your cholesterol level, you may want to start by looking at different plant-based diets. There are many different approaches which vary across a spectrum of strictness. 

For example, vegan diets are generally more strict than vegetarian diets. You may choose to eliminate all animal products or only eat certain types, such as eggs or fish.

Flexitarian diets don’t have set rules and generally allow you to customize a plant-based diet to better suit your personal tastes, dietary needs, and preferences. 

Plant-based diets have been shown to reduce the risk of heart disease and obesity—two factors that promote healthy cholesterol levels. Plant-based diets are also focused on whole foods and avoid processed foods high in sugar and trans fats.

There are many examples of plant-based diets you can explore, including:

• Engine-2 Diet: A low-fat plant-based diet that includes legumes, whole grains, fruits and vegetables, nuts, and seeds. In addition to excluding animal products, vegetable oils are not allowed on the Engine-2 Diet. 
• Raw Food Diet: The majority of the food on this diet is eaten uncooked, including fruits, vegetables, nuts, and seeds. Legumes and grains can be cooked using very low heat (less than 118 degrees Fahrenheit). Most raw food diets are vegan, though some people choose to include raw milk. 

The Therapeutic Lifestyle Changes Diet, or TLC diet, was specifically designed by the National Cholesterol Education Program (NCEP) to help people lower their cholesterol and triglyceride levels. 

Following the TLC diet you’ll reduce your daily intake across the board, but especially saturated and trans fats, while focusing on healthy portions of complex carbohydrates, lean protein, and soluble fiber. The TLC diet also recommends limiting your sodium intake to 2400 milligrams or less per day.

If you have high cholesterol, there are some factors you don’t have any control over—such as your family history and age. However, you can make changes in your life that can help keep your cholesterol levels in a healthy range or lower them if they do become elevated. 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 fats 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.