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Cholesterol-Lowering Diet

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The primary goal of this diet is to lower your levels of low-density lipoprotein (LDL), or bad, cholesterol. This diet may also raise your levels of high-density lipoprotein (HDL), or good, cholesterol. Having too much LDL cholesterol, and/or not enough HDL cholesterol, can lead to a condition known as atherosclerosis , which causes plaque to build up in your arteries. Plaque buildup narrows and hardens your arteries, increasing your risk of having a heart attack or stroke.

Cholesterol and Cardiovascular Disease Risk

Cholesterol level is one factor considered when determining your overall risk of having a heart attack, heart disease, or stroke. Other factors that are considered include:

A cholesterol-lowering diet may be recommended if you are at high risk for heart disease or stroke. The goal of this diet is to lower bad cholesterol and increase good cholesterol.

Diet and Cholesterol

Diet is just one of the factors that affect the level of cholesterol in the body. Adjusting certain elements in your diet may help to lower your blood cholesterol levels.

Fat

Fat is an essential nutrient with many responsibilities, including transporting the fat soluble vitamins A, D, E, and K, protecting vital organs, and providing a sense of fullness after meals. Fat can be broken down into four main types:

Fats that increase LDL levels and should be avoided or limited:

Saturated fat

Found in margarine and vegetable shortening, shelf stable snack foods, and fried foods, it increases total blood cholesterol, especially LDL levels.

  • Animal fats that are saturated include: butter, lard, whole-milk dairy products, meat fat, and poultry skin
  • Vegetable fats that are saturated include: shortening, palm oil, coconut oil, and cocoa butter

Hydrogenated or trans fat

Found in margarine and vegetable shortening, it increases total blood cholesterol, including LDL levels. It also decreases HDL levels.

Fats that improve cholesterol profile and should be eaten in moderation:

Monounsaturated fat

Found in oils such as olive and canola, it can decrease total cholesterol level while keeping levels of HDL high.

Polyunsaturated fat

Found in oils such as safflower, sunflower, soybean, corn, and sesame, it can decrease total cholesterol.

Less than 7% of calories should come from saturated fat on a cholesterol-lowering diet. Trans fat intake should be less that 1% of calories with a goal to eliminate them completely.

On an 1,800 calorie diet, this translates into less than 20 grams of saturated fat per day, leaving 40 grams to come from mono- and polyunsaturated fats.

Cholesterol

Dietary cholesterol is found only in animal products. Although dietary cholesterol can increase LDL cholesterol, it does not affect it nearly as much as saturated or trans fats. On a cholesterol-lowering diet, you should consume no more than 200 milligrams of cholesterol a day.

Fiber

Eating a diet high in soluble fiber can help lower your LDL cholesterol. There are two main types of fiber: soluble and insoluble. While both are very important to health, only soluble fiber impacts cholesterol levels. When soluble fiber is digested, it dissolves into a gel-like substance that helps block the absorption of fat and cholesterol into the bloodstream.

Soluble fiber is found in foods such as oatmeal, oat bran, barley, soy products, legumes, apples, and strawberries. On a cholesterol-lowering diet you should consume at least 5-10 grams of soluble fiber per day, and ideally 10-25 grams.

Stanols and Sterols

Stanols and sterols are substances found in certain plants. Plant stanols and sterols can lower LDL cholesterol levels in a similar way to soluble fiber, by blocking their absorption from the digestive tract. Certain foods, including margarines and orange juice, are now being fortified with these cholesterol-lowering substances. Research shows that consuming at least 2 grams of plant stanols or sterols a day can reduce LDL cholesterol by more than 10%.

Eating Guide for a Cholesterol-Lowering Diet

Food Category Foods Recommended Foods to Avoid
Grains
  • Whole grain breads and cereals, pasta, rice, potatoes, low-fat crackers
  • High-fat baked goods like muffins, donuts, and pastries
  • Crackers made with trans fat
Fruits
  • All; choose whole fruit over juice for added fiber
  • None
Vegetables
  • All
  • Vegetables with added fat or sauce
Milk
  • Nonfat or low-fat (1%) milk
  • Nonfat or low-fat yogurt, sour cream, buttermilk
  • Cottage cheese, low-fat cheeses
  • Whole milk
  • Reduced-fat (2%) milk
  • Malted and chocolate milk
  • Most cheeses
Meat and beans
  • Lean cuts of beef, pork, veal, or lamb (look for the word loin or round; trim visible fat before cooking
  • Poultry without the skin
  • Fish and most shellfish; limit your intake of shrimp
  • Egg whites and egg substitutes; limit whole eggs to two per week
  • Tofu
  • Seeds, nuts; peanut butter should be eaten in moderation due to high calorie content
  • Dried peas, beans, and lentils
  • Fatty cuts of meat
  • Organ meats like brain, liver, and kidneys
  • Poultry skin
  • Breaded fish or meats
  • More than two egg yolks per week, including those found in baked goods, cooked foods, or processed foods
Fats and oil
  • Vegetable oils high in unsaturated fat like olive, canola, corn, safflower, or soybean
  • Trans fat-free soft or liquid margarines; the first ingredient should be unsaturated liquid vegetable oil
  • Stanol/sterol-containing margarine
  • Low-fat salad dressings and mayonnaise
  • Butter, stick margarine, coconut and palm oils, bacon fat
  • Salad dressings made with egg yolk
Snacks, sweets, and condiments
  • In moderation: Fat-free or low-fat cookies, ice cream, frozen yogurt; sherbet; angel food cake; baked goods made with unsaturated oil or trans-free margarine, egg whites or egg substitutes, and nonfat milk; jello; candy made with little or no fat like hard candy or jelly beans
  • High-fat desserts; baked goods made with butter, lard, shortening, egg yolks, or whole milk

Suggestions

Food Selection

  • Make whole grains, fruits, and vegetables the base of your diet.
  • Look for products that are labeled as fat free, low-fat, cholesterol free, saturated fat free and trans fat free. However, a product can claim no grams trans fat, even on the label, but still have a small amount. Be sure to look for partially hydrogenated oil. If a product has this, avoid it.
  • Become familiar with the Nutrition Facts panel, which lists information, such as the amount of calories, saturated fat, trans fat, and cholesterol per serving of the item.
  • Eat foods rich in omega-3 fatty acids. These include fatty fish such as salmon, mackerel, and tuna; flaxseed; walnuts; canola oil. Eating fish at least 2 times a week is more effective than omega-3 fatty acid supplements. In fact, evidence about the benefits of supplements is not conclusive.

Try different foods and make changes based on what you like to eat. It may take some time to get comfortable with new changes.

Meal Preparation

  • Prepare foods by using low-fat methods, such as steaming, boiling, grilling, poaching, baking, broiling, or roasting. If you are sautéing or stir frying, use a cooking spray or small amount of vegetable oil.
  • Trim any visible fat off meat or poultry before cooking. Drain the fat after browning.
  • Limit high-fat sauces. Add zest to foods by topping them with low-fat items such as fresh herbs, salsas, or chutneys.
  • Increase fiber by adding fruit to your cereal or yogurt, beans to your salad, and choosing whole grain breads.
  • Cook at home more often. Restaurant food tends to be high in fat and calories.

Other

  • Engage in at least 30 minutes of moderate to vigorous physical activity most days of the week.
  • If you are overweight, talk with your doctor about the best methods to lose weight.
  • Talk to a registered dietitian for individualized diet advice.
  • Eat Right—Academy of Nutrition and Dietetics

    http://www.eatright.org

  • National Heart, Lung, and Blood Institute

    http://www.nhlbi.nih.gov

  • Dietitians of Canada

    http://www.dietitians.ca

  • Heart and Stroke Foundation of Canada

    http://www.heartandstroke.ca

  • About cholesterol. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/About-Cholesterol%5FUCM%5F001220%5FArticle.jsp. Updated July 31, 2014. Accessed November 12, 2014.

  • Dietary guidelines for Americans 2010. US Department of Agriculture and US Department of Health and Human Services. Available at: http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf. Accessed November 12, 2014.

  • Dietary interventions for cardiovascular disease prevention. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 20, 2014. Accessed November 12, 2014.

  • Eckel RH, Jakicic JM, et al. 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-S99.

  • Goff DC Jr. Lloyd-Jones DM, et al. 2013 ACC/AHA guideline on the assessment of cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;63(25 pt B):2935-2959.

  • Harland JI. Food combinations for cholesterol lowering. Nutr Res Rev. 2012;25(2):249-266.

  • Hypercholesterolemia. EBSCO DynaMed website. Available at: http://www.ebscohost.com/dynamed. Updated October 2, 2014. Accessed November 12, 2014.

  • Lowering your cholesterol with TLC. National Heart, Lung, and Blood Institute website. Available at: http://www.nhlbi.nih.gov/health/public/heart/chol/chol%5Ftlc.pdf. Published December 2005. Accessed November 12, 2014.

  • What your cholesterol levels mean. American Heart Association website. Available at: http://www.heart.org/HEARTORG/Conditions/Cholesterol/AboutCholesterol/What-Your-Cholesterol-Levels-Mean%5FUCM%5F305562%5FArticle.jsp. Updated August 15, 2014. Accessed November 12, 2014.